Chapter 24 Informatics Flashcards
Nurses who work in the field of NI support __________
the ability to access info
Early 1970s nurses began to adopt and apply computer science in 4 ways
Document patient visits,
Self-care Instructions,
Track Inventory of meds and equipment,
Computer based patient records
3 Reasons why HC is behind other fields in technology and information use
HC is complicated—each patient unique
Process of providing HC involves many disciplines, agencies, etc
Patient info is confidential and private
Two levels of skills/knowledge for modern practice
Basic Level (every nurse needs) Specialist Level (a nurse informatics specialist—Master’s level)
Nursing Informatics Basic Competencies (3 core areas and competencies below each)
- IT Use in HC
a. Computer hardware
b. Computer software
c. Networks and health informatics - Information Management in HC
a. Data, information, and knowledge
b. Information security, privacy, and confidentiality (protecting) - IT Systems Use in HC
a. Information systems
b. Clinical, decision support, and administrative
In order to meet the basic competencies you must be able to use certain technological and intellectual tools such as:
- Computer software (EHRs)
- Hardware (desktop computers, laptops, mobile devices)
- Medical devices (IV pumps, ventilators)
Canada’s e-health strategies plan says that future nurses will be able to do the following 7 things:
- Integrate info and communication technologies (ICTs) into practice to achieve positive patient outcome
- ID info and knowledge required to support practice
- Better plan to address nursing human resource needs
- Develop new models of nursing practice and health services delivery that will be supported
- Connect nurses to develop patient care solutions
- Improve quality of nurses’ work environments using ICTs
- Contribute to the global nursing community
As a nurse you need to find information in order to:
This information must be
a. Support practice decisions
b. Keep knowledge current/up-to-date
professional, scholarly, and current
Professional nursing literature is organized in two ways:
- Published Literature (books, journals, and trade magazines)
- Indexes for Nursing:
a. CINAHL (abstracts, titles, and some full text)–BEST FIRST SOURCE
b. MEDLINE (references to journals) - Published Reports, Discussion Papers and Data (from nursing and HC agencies
- “gray literature” harder to find-not usually in indexes but on professional website
- may be harder to evaluate accuracy of some info/mislead
What is the best first source of information? What is another good source?
Cumulative Index for Nursing and Allied Health Literature (CINAHL)
Textbooks recommended by faculty
First competency for nursing informatics:
Ability to find and retrieve professional nursing knowledge
In searching for and finding nursing info, you are developing ____________ skills
information literacy
Information literacy is the ability to do 3 things:
- Know when information is needed
- Being able to find it
- Being able to effectively use that information
The first step toward becoming information literate is:
knowing what is correct, reliable, and ready to bring to practice
When a patient asks you about a source of information they found on the internet, what 2 things should you consider?
- The source
2. If the information comes with cited references
When dealing with information patient’s get from the web, the role of the nurse is understanding these three things:
- Where the patient obtained their information
- How they use this information
- How you can help them identify credible sources of health information
What information about the patient do you need to know before providing care?
Current state of health
Tx being provided
Possible risks and projected outcomes of the tx plan
What is an EHR?
Electronic Health Record
- comprehensive digital record of HC info and encounters with HC system; available in real time
- transportable, longitudinal data used by all
- data may include: lab values, digital imaging, pharmaceutical info, transcribed reports, clinical documentation
- data entered according to international standards so that it is retrievable and readable
2 Advantage of an EHRs
Data can be used to evaluate a patient’s condition over time
Data can be pooled from several patients to evaluate how well a place is reaching patient care goals
4 Benefits of EHRs to Nursing
Readily employed to develop care plans
Communicate findings to other HCPs
Analyze staffing/budgets to efficiently manage resources
Evaluate impact of nursing care on health of individual and community
________ and ________ are not transportable or longitudinal
EMRs and EPRs
What is an EMR, what does it contain, and who has access to it?
Electronic Medical Record
- found in private practitioners office or in a clinic
Content: interaction with clinic or office providing direct care
Access: HCPs at office or clinic
What is an EPR, what does it contain, and who has access to it?
Electronic Patient Record
- found in HC organization like hospital and long-term care
Content: Used by HCPs involved with patient care at organization (hospital)
Access: HCPs working at institution who need to know info to provide care
What is in an EHR and who has access to it?
Lifetime health status; interaction with health system
The individual determines who has access and which parts are available to who
What is BC Nursing Health Services Research Network: InspireNet and what is it’s purpose?
Innovative Services and Practice Informed by Research and Evaluation
Purpose: develop capacity for nursing research and give opportunity for members to join Action Teams
What is an eCOP and what do people do in them?
Electronic communities of practice. Professionals can interact, exchange knowledge, mentor, or plan work together
Nursing informatics specialists work with nurses to _________________________
design, develop, implement, and optimize the use of differing technologies
What are 3 things mobile phones can be used for?
Communicate health status, needs, coordinate or manage care
What are 2 things that phones are affecting?
Way we search & use info in decision-making
How we communicate about patient care
In the future, nurses will use mobile devices to do which 3 things?
Review patients information
Read journal article
Call another member of HC team
RNAO best practice guidelines are accessible via _________
mobile phone
UHN in Toronto uses mobile phones to:
Other organizations are developing ________ support tools accessible via mobile phone
communicate
have up to date research
have patient info
decision
What is a COW?
Computer on wheels; carts with laptops
What do COWs do, how to they help nurses?
- able to send and receive info
- allow nurse to view patient EPR and enter new assessment info while with patient
- sometimes have standard assessment format that can be used to obtain new data and update record
- medication administration systems
Medication administration systems on COWs allow nurses to do 2 thing:
- Use information to support decision-making prior to administering a medication
- Bedside documentation after medication administration
What kind of HC devices will be integrated with and automatically recorded to EPR?
- Monitor patient health (cardiac monitor)
- Deliver treatments (IV pumps)
- Sustain life (ventilator)
What is one of the most important nursing activities?
Documentation
Documentation includes which 5 things?
- Recording of objective and subjective data
- Our assessment of the data
- Planning and implementation of care related to data
- Evaluation
- Communicating with other HC team members
We need to document our assessments in an understandable format so that others know:
What we have observed
What we judge as the plan of care
What the appropriate nursing actions need to be for the nurse or nurses that work with the patient
One of the major purposes of clinical documentation is that information be _______, ________, and ________ by the nurse providing care in the moment
Available, noticed, and retrievable
Health condition is recorded in _______ into an EHR with WHO’s ___________________; psychiatric conditions come from the ______________
Numeric code
International Classification of Disease (ICD)
DSM
Advantage to collecting data electronically/using e-records is the ability to ___________
build reminders of best practice and decision supports into the records—alert the nurse to issues that may have critical relevance to care
If data is in an EHR, it can be retrieved later to look back on the nursing ________, _______, and ____________ to determine ________________ and _______________
the nursing judgements, care and outcomes
probable outcomes of nursing practice and answer Qs about the patient groups
What are three concerns about using standardized documentations systems in nursing?
- If a standardized documentation system can adequately record nursing practice
- Which of the several nursing systems available should be used
- Concerns about privacy, use, and access to any compilation of personal data
Why is using standardized e-documentation difficult in nursing?
because nursing focuses on the individualization of care to meet specific patient needs
Why are some nurses against standardized systems?
- they represent an intrusion into the integrity of the nurse-patient interaction
- see it as adoption of a paternalistic model of practice
Whether or not nursing moves to become part of the electronic records will have these implications:
- Nurses’ ability to evaluate trend data
- Document nursing outcomes
- Be evident in systems that will record data on paperless form
The ability of one health information system to talk to another system and be understood is referred to as _________
Interoperability
Define what a data set is and give an example.
Definition: clusters of coded data, used on a regular basis by most HCPs delivering care
Example: NMDS (Nursing Minimum Data Set)
What is NMDS? What is it’s intent? What does it include?
Nursing Minimum Data Set
- Set of items–provide accurate description of basic patient, nurse and provider information
- ->16 basic elements
Intent: provide a standardized data format to ensure consistent data entry, accessibility and retrievability of nursing information
Nursing’s initial attempt to standardize collection of essential data
Remains a formal structure for electronic recording of the minimal elements required to document patient care
What was nursing’s initial attempt to standardize collection of essential data?
NMDS
Define what a Classification System (Scheme) is. Give two nursing examples and two examples from other disciplines that nurses use.
- Assignment of objects into groups of terms based on common characteristics (Ex. origin, composition, structure, function)
- Provide common terms for the patient care elements (such as those recorded in the NMDS)
- Has criteria for inclusion as a CS
Example: NIC (4th edition; 452 interventions), NOC (5th edition; 385 outcomes), ICD, DSM
The ICD and the DSM are examples of:
Classification Systems
What are the 4 criteria for inclusion as a Classification System?
- Terms are clinically useful
- Terms are clearly defined
- Having a process for review at periodic intervals
- Having unique identifiers or codes
What is a Taxonomy? What else can it be called? What is an example?
Controlled Vocabulary or languages that are a restricted set of phrases, numerated and arranged in a hierarchy
Taxonomic terms are coded to enable clinicians to capture clinical data at the POC and are amenable to use in an electronic environment
Ex. NANDA-I taxonomy of nursing diagnoses
What is NANDA-I and how is it organized?
Taxonomy of nursing diagnoses
137 diagnostic labels with definitions and defining characteristics of each
The taxonomy’s hierarchy has 3 levels:
- Domains (4)
- Classes (27)
- Nursing Diagnoses (137)
The taxonomy adds axes to each diagnosis to provide for a diagnostic statement that includes a depiction of the diagnostic process
What is a Translational Vocabulary? Give an example.
Clinical terminology systems used in building HC records that permits information systems to talk to each other–map information across systems
Permits data interchange
Likely to occur when there are records from many different places that all deal with the same patient population
Example: SNOMED-CT (Systemized Nomenclature of Medical Clinical Terms)
What does SNOMED-CT stand for and what is it?
Systemized Nomenclature of Medical Clinical Terms
It is a translational vocabulary
Data entered into a system using a medical diagnostic system (such as ICD), a psychiatric system (DSM) and a nursing system can map information across systems
In the process of incorporating the ICNP—already has other nursing languages included
Endorsed by Canada Health Infoway (CHI)
What is CHI? What does it do? What does it endorse?
Canada Health Infoway ( a non-profit)
Works with provinces and territories to accelerate the use of EHRs as a Canadian standard
Endorses SNOMED-CT
What is ICNP and why was it developed?
International Classification of Nursing Practice (ICNP)
Need a unifying language that support data reuse and comparison of data captured and comparative outcome analysis
It can also be readily translated for cross-cultural international use
The alpha version of the ICNP was released as a _______a_________ that would present these 3 nursing phenomena of concern: b
The current version contains a ___________c______________ that is composed of subsets of _______d____, ____d______, and ___d_______ specific to various areas of practice
a. standardized vocabulary
b. Nursing diagnosis, nursing interventions, nursing outcomes
c. catalogue of precombined terms
d. diagnoses, actions, outcomes
ICNP was designed to be used in two ways
- Compositional vocabulary (list of nursing terms, much like a classification scheme)
- Terminology reference (it can provide a means for cross-mapping terms of existing nursing terminology to enable comparisons of nursing data across organizations and various health sectors
__________ is not a taxonomy or classification system—it is a comprehensive vocabulary for nursing that permits computerized documentation of all aspects of nursing judgments, activities, and outcomes
ICNP
What 7 axes does the ICNP include and why are they needed?
- focus of nursing attention
- nursing judgement
- statement about who the patient is
- nursing action
- means of carrying out nursing action
- location of care
- time period involved in the nursing encounter
Needed for the inclusion in EHRs
What are some challenges encountered with the ICNP?
- ICNP terms are fairly straightforward but the volume of concepts required for full documentation is A LOT
- integrating the systems into mainstream practice
- considerable education nurses need on systems/cross-mapping
How to attribute meaning and develop consistent reliable meanings for all terms in the ICNP?
- Nurses could document meanings attributed to terms at local/regional or national levels (like other countries that have already addressed this issue of terms)
- Could use terms as defined in other existant systems and cross-map with the ICNP
What does the NOC include? What is the problem with it?
The NOC (nursing classification system) does include many nursing outcomes and provides computer-coding and measurement tools for each outcome
Problem: it’s uptake is dependent on universal use of the system in all areas and specialty practices within the discipline and access to this system on electronic records is limited
What is a major project and Canadian initiative that originated through an agreement between CNA and CHI for use in EHRs?
Canadian-Health Outcomes for Better Information and Care (C-HOBIC)
What does C-HOBIC stand for?
Canadian-Health Outcomes for Better Information and Care
What were the 3 objectives of the C-HOBIC project?
1.Standardize the language concepts used by C-HOBIC to ICNP
- Capture patient outcome data related to nursing care across four sectors of the health system:
a. Acute care
b. Complex continuing care
c. Long-term care
d. Home care
3.Store captured and standardized data in relevant, secure jurisdictional data repositories or databases in preparation for entry into provincial EHRs
This was the first effort in the country that addressed nursing’s need to systematically record intake and outcome assessment dat and begin to relate that data to nursing activities. It was also the first effort in defining and understanding the use of ICNP–because the project maps to it
C-HOBIC
C-HOBIC 5 Outcomes and Measures
- Functional Status
Measures: self performance of ADL rated on measures of level of independence - Therapeutic Self-Care
Measures: readiness for discharge–measures of knowledge of self care requirements - Symptom Management
Measures: measures of intensity, duration and frequency of symptoms - Safety (falls, pressure ulcers)
Measures: number of falls in unit of time; number of pressure ulcers, staging of ulcers - Patient Satisfaction with Care
Measures: satisfaction measures
Guidance and work related to privacy and ethics in informatics comes from:
The CNA Code of Ethics principle #5 (nurses recognize importance of privacy and confidentiality…)
International standards about how data in EHRs will be coded and transmitted to ensure P&C are established through the ______________________
International Organization for Standardization (ISO) in Geneva
What is HL7?
Health Level Seven (HL7) sets standards for functional interoperability and exchange of data across systems
- Level 7 means standards are at the 7th or highest messaging level—dictate protocols used for transmission and exchange meet most stringent standards for privacy
Superuser
A generalist user who has detailed knowledge about the new technology.
They help other nurses who are using the technology for the first time in a real world setting to effectively use and integrate it
Technology Champion
individual who helps others learn about the new technology and advocates for users when modifications are required
What is a manager’s role in informatics? Data can support a manager in 3 ways.
Describe issues your staff are having to the IT department; speak with chief nursing officer about concerns or how tech is affecting nursing practice
Can support:
- decision making
- provide info on types of pts cared for on your unit
- assess effectiveness of ns interventions currently in use
What is a leader-CNS? What do they recognize? What 4 tasks should they complete when introducing a practice change?
Leader-Clinical Nurse Specialist
Recognizes power of technology to act as one more tool to support nursing practice
When intro practice change, CNS should consider:
- Teaching a nurse about the change
- Describing the associated policies and procedures
- Providing told to make the change
- Revising technologies nurses use to further support practice changes
