Foundation of Practice Flashcards
What are the foundations of practice
A. Professional practice
B. Methodologies & Theories
C. Rules, regulations, & requirements
D. Interprofessional collaboration
ANA definition of NI (2008)
Nursing informatics is a specialty that: A. integrates nursing science B. Computer science C. Information science to manage and communicate: 1. Data 2. Information 3. Knowledge and 4. Wisdom in nursing practice NI Supports: a. consumers b. patients c. nurses d. other providers in their decision-making in all roles and settings. This support is accomplished through: i. use of information structures ii. information processes iii. information technology
ANA definition of NI (2015)
NI is a specialty that integrates nursing science with multiple information and analytical sciences to: A. Identify B. Define C. Manage and D. Communicate data, information, knowledge, and wisdom in nursing practice NI supports: 1. Nurses 2. Consumers 3. Patients 4. Users 5. Interprofessional healthcare team 6. Other stakeholders in their decision-making roles and settings to achieve desired outcomes
This support is accomplished through the use of:
a. information structures,
b. information processes, and
c. information technology
Tenents (beliefs) of Nursing Informatics
- A unique body of knowledge, preparation, and experience that aligns with the nursing profession.
- Involves the synthesis of data & information into knowledge & wisdom
- Supports decision-making of healthcare consumers, nurses, and other professionals achieve healthcare consumer safety and advocacy
- Supports data analytics, including quality of care measures, to improve population health outcomes and global health
- Promotes data integrity and the access and exchange of health data for all consumers of health information
- Supports national and international agendas of interoperability and the efficient and effective transfer and delivery of data, information, and knowledge
- Ensures that collaboration is an integral characteristic of practice
- Interleaves user experience and computer-human interaction concepts throughout practice
- Incorporates key ethical concerns of NI such as advocacy, privacy, and assurance of the confidentiality and security of data and information
- Considers the impact of technological changes on patient safety, healthcare delivery, quality, reporting, and the nursing process
- Leads in the design and promotion of useful, innovative information technologies that advance practice and achieve desired outcomes
(Scope & Standards )
What year did the ANA identify NI as a nursing specialty?
1992
When was the first scope of practice statement for NI published?
1994
When was the ANA Standards of Practice for NI released?
1995
When was the scope and standards of NI practice released combining both scope and standards of practice?
2001 then updated in 2008
What are analytical sciences?
A listing of sciences that integrate with NI includes:
- computer science
- cognitive science
- science of terminologies and taxonomies (including naming and coding conventions)
- information management
- library science
- heuristics
- archival science
- mathematics
What are the NI competencies for all RNs?
TIGER-Technology informatics guiding education reform identified that all nurses in every role must be prepared to make HIT. TIGER formed an informatics competency collaborative which defines the competencies recommended for the NI discipline:
- Basic computer skills
- Information literacy
- information management
According to Staggers, Gassert, Curran 2002, what are the levels of informatics competencies?
- Beginning nurse
- Experienced nurse
- Informatics nurse specialist
- Innovator
Name some additional competencies
- Pierce, Tanner, & Pravikoff (2005) information literacy
- Telehealth competencies (ATA, ICN)
- Genetics & genomics competencies
- National league for nursing
- Amer Assoc of College of Nurses
- Forecasting informatics competencies for nurses in the future of connected health IOS Press 2017
Name the types of roles
- Project manager
- Decision support/outcomes
- Educator
- Product developer
- Systems analyst
- Consultant
- Programmer
- Advocate/policy developer
- Web developer
- CIO/CNIO
- Entrepreneur
- Researcher
- Sales and Marketing
- Consumer advocate
What are the functional areas: Informatics nurses
- Administration, leadership, & management
- Systems analysis & design
- Compliance & integrity management
- Consultation
- Coordination, facilitation, & integration
- Development
- Educational & professional development
- Genetics & genomics
- Information management/operational architecture
- Policy development & advocacy
- Quality & performance improvement
- Research & evaluation
- Safety, security & environmental health
What are the standards of nursing informatics Practice?
- Evaluates quality & effectiveness of NI practice
- Performance appraisal
- Maintains knowledge and NI competency-life-long learning
- Contributes to the professional development of others
- Bases decisions and actions on ethical principles
- Collaborates with others
- Contributes to the body of informatics research
- 16 Standards are highlighted with measurement criteria
What are the NI Standards of practice?
Standard 1: Assessment Standard 2: Diagnosis, Problems & Issues Identification Standard 3: Outcomes Identification Standard 4: Planning Standard 5: Implementation Standard 6: Evaluation Standard 7: Ethics Standard 8: Education Standard 9: Evidence-Based Practice and Research Standard 10: Quality of Practice Standard 11: Communication Standard 12: Leadership Standard 13: Collaboration Standard 14: Professional Practice Evaluation Standard 15: Resource Utilization Standard 16: Environmental Health ADOPIEEEEQCLCPRE
What makes up EBP?
- Literature searches
- Clinical practice guidelines
- Clinical protocols
Boolean search
Definition of EBP
- A problem-solving approach to clinical decision-making within a healthcare organization
- Integrates best available scientific evidence with best available experience
- Uses research & non-research evidence (ethical or personal)
Evidence-Based nursing practice is the process:
By which nurses make a clinical decision using:
- The best available research evidence
- Their clinical expertise
- Patient preferences
Formulating answerable clinical questions is the foundation of EBP.
- Start with the patient: clinical problems & questions arise out of patient care
- Translate the clinical questions into a searchable question using PICOT
- Decide on the best type of study to address the question
- Perform a literature search in the appropriate sources
What is the PICOT model to support EBP
P-Population/condition I-Intervention C-Comparison O-Outcome T-Time of study
What is the ACE Star Model of EBP (2004)?
5 points of knowledge transformation:
- Discovery
- Summary
- Translation
- Integration
- Evaluation
NI support nurses, consumers, patients, interprofessional healthcare team, and stakeholders through the use of which three things?
- Information structures
- Information processes
- Information technology
Name a Metastructure
DIK (Blum-1986) 1. Data 2, Information 3. Knowledge 4. Wisdom DIKW (Graves & Corcoran-1989)
What is Data?
Discrete entities that are described objectively with interpretation
What is Information?
Data that have been:
- Interpreted
- Organized or
- Structured
What is Knowledge?
Information that is synthesized so that relationships are identified and formalized
Focuses on what is known
The appropriate use of knowledge involves?
Integration of empirical, ethical, personal, and aesthetic knowledge into actions
What is Wisdom?
The appropriate use of knowledge to manage and solve human problems.
It consists of knowing when and how to apply knowledge to deal with complex problems or specific human needs
Focuses on the appropriate application of that knowledge and an appreciation of the consequences of selected actions
Example of DIKW
(D) A nurse receives list of numbers (28, 68, 94, 98, 110) which are just raw data and meaningless
(I) If the numbers are ordered or structured and identified as follows: T 98, P 94, R, 28, BP 110/68, the nurse recognizes this series and measurements of vital signs and will regard those numbesrs as information
(K) Applying context to the information knowing that these numbers mean different things in different populations such as NB and Adults.
(W) Nurse can take appropriate action
Relationship of Data, Information, Knowledge, and Wisdom
Nelson 2002
Data - naming, collecting, and organizing
Information - Organizing and interpreting
Knowledge - Interpreting, integrating, and understanding
Wisdom - Understanding, applying and applying with compassion
NI is concerned with
Creation Structure Storage Delivery Exchange Interoperability Reuse of nursing and clinical information along the continuum of care.
What is the informatics nurse specialist often responsible for?
Implementing or coordinating projects
involving multiple professions and specialties
Support other RNs to best use data, information, knowledge, and technology
NIs support through the use of:
Information structures
Information processes
Information technology
NIs Foci
Information user, information recipients, exchange data, information, knowledge, and wisdom
Design, structure, interpretation, and representation of data, information, knowledge, and wisdom
Design, develop, implement, and evaluate applications and technologies, ensuring their safety, quality, effectiveness, efficiency, and usability
Standardized terminologies
Have become a significant vehicle for facilitating interoperability between different concepts, nomenclatures, and information systems
How is the HITECH’s act (2009) continuing to evolve, map, and integrate concepts as well as research efforts in today’s terminology environment?
HITECH funding continue to stimulate more rapid movement towards electronic data capture and health information exchange (HIE)
Two examples:
1-International classification for nursing practice (ICNP)-developed and maintained by the International Council of Nurses (ICN), provides a global cross-map of nursing terminologies and unite practice through comparison, new research generation, and to inform and influence health policy. ICNP has harmonized with SNOMED CT and offers more than 18 diff translations
2-Systematized Nomenclature of Medicine or (SNOMED CT) is a comprehensive universal healthcare reference terminology and messaging structure. Enables multiple nursing terminology systems to be mapped to one another thru harmonized concepts.
ANA Recognized terminologies and data element sets
Data Element Sets
ANA-Recognized Informatics System Data Element Sets: 1-Nursing Minimum Data Set (NMDS) 1-Developed by nursing 1-Contains: Clinical data elements
2-Nursing Manamgnet Minimum Data Set (NMMDS)
2-Developed by all settings
2-Contains: Nursing administrative data elements
ANA Recognized terminologies and data element sets
Nursing-Developed Terminologies
CCC-Clinical Care Classification System
Developed by-all nursing care & other HCP
Contains-Dx, interventions, & outcomes
ICNP-International Classification for Nursing Practice
Developed by-all nursing
Contains-Dx, interventions, & outcomes
NANDA-NANDA International
Developed by-all nursing
Contains-Dx
NIC-Nursing Interventions Classification
Developed by-all nursing
Contains-Interventions
NOC-Nursing Outcomes Classification
Developed by-all nursing
Contains-Outcomes
Omaha System-
Developed by-Home care, public health, & community
Contains-Dx, interventions, & outcomes
PNDS-Perioperative Nursing Data Set
Developed by-perioperative care setting
Contains-Dx, interventions, & outcomes
ANA Recognized terminologies and data element sets
Multidisciplinary Terminologies
ABC-ABC Codes
Developed by-Nursing and other HCP
Contains-interventions
LOINC-Logical Observation Identifiers, Names, and Codes
Developed by-nursing and other HCP
Contains-outcomes and assessments
SNOMED CT-Systematic Nomenclature of Medicine Clinical Terms
Developed by-nursing & other HCP
Contains-Dx, interventions, & outcomes
Office of the National Coordinator (ONC) for Health Information Technology (HIT)
A joint effort by US Federal Govt to standardize terms to describe HC practice
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
CVX
Codes for Vaccines Administration
Setting application-nursing and other
Content-vaccines (administered)
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
CPT
Current Procedural Terminology
Setting application-other
Content-medical, sx, & dx services rendered for claims
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
CDC-PHIN/VADS
CDC-Public Health Information Network/Vocabulary Access and Distribution System
Setting application-nursing and other
Content-patient characteristic (admin gender, DOB)
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
HCPCS
Healthcare Common Procedure Coding System
Setting application-other
Content-medical, sx, dx services rendered for claims
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
ICD-9 CM
International Statistical Classification of Diseases and Related Health Problems-Procedural Coding System (9th ed)
Setting application-nursing and other
Content-Dx and assessments
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
ICD-10 CM
International Statistical Classification of Diseases and Related Health Problems-Clinical Modification (10 ed)
Setting application-nursing and other
Content-Dx and assessments
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
ICD-10 PCS
International Statistical Classification of Diseases and Related Health Problems-Procedural Coding System (10th ed)
Setting application-nursing and other
Content-dx and assessments
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
ICF
International Classification of Functioning, Disability, and Health
Setting application-nursing and other
Content dx-functional status
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
ISO-639
International Organization for Standardization Standard 639
Setting application-nursing and other
Content-representation of languages & language groups
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
LOINC
Logical Observation Identifiers, Names, and Codes
Setting application-nursing and other
Content-outcomes and assessments
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
RxNORM
RxNORM
Setting application-nursing and other
Content-normalized clinical drug names
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
SNOMED CT
Systematic Nomenclature of Medicine Clinical Terms
Setting application-nursing and other
Content-Dx, interventions, & outcomes
ONC HIT Standards Committee Recommended Clinical Vocabulary Standards:
UCUM
Unified Code for Units of Measures
Setting application-nursing and other
Content-Units of measure for results
What does HL7 Stand for?
Health Level Seven International
What does IHTSDO stand for?
International Health Terminology Standards Development Organization
What 4 tools from Information Science & computer science are fundamental to NI?
1: Information Management-elemental process by which one files, stores, manipulates, and reports data for various users
2: Information Communication-enables systems to send data and to present information in formats that improve understanding
3: Information Structures-organize data, information, and knowledge for processing by computers
4: Information technology-includes computer hardware, software, communication, and network technologies, derived from computer science.
ISO 9241-11 : Usability
The extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction.
Fundamentally about patient safety and human performance with tools and systems
Resources promoting details about usability are?
1: Health Information & Mgmt Systems Society (HIMSS_
2: National Institute of Standards and Technology (NIST)
3: US Food & Drug Admin (FDA)
4: TIGER Initiative
5: Jakob Nielsen of the Nielsen Norman Group
What does HCI examine?
The interaction and influence between
people
software applications
computer technology
Rooted in:
psychology
cognitive science
sociology
computer science
information science
What does HCI address?
Design Development Procurement Implementation Evaluation
of applications as well as other components associated with the SLC
The Human Factors and Ergonomics Society (HFES) identifies ergonomics (human factors) as:
the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design in order to optimize human well-being and overall system performance
The concepts of efficiency, effectiveness, and safety are integral and apply to the client, consumer, and others
The International Organization for Standardization (ISO) 9241-11 defines user experience as:
a person’s perceptions and responses that result from the use or anticipated use of a product, system or service
Staggers (2014) identified interrelationship of the user experience as:
Encompassing human factors, HCI, ergonomics, and usability
What are the 4 key concepts of metaparadigm of nursing?
Nurse
Person
Health
Environment
What are the Functional areas of NI?
Administration, leadership, & management
Systems analysis & design
Compliance & integrity management
Consultation
Coordination, facilitation, & integration
Development of systems, products, & resources
Educational & professional development
Genetics & genomics
Information management/operational architecture
Policy development & advocacy
Quality & performance improvement
Research & evaluation
Safety, security, & environmental health
What are the Functional areas of NI?
Administration, Leadership, and Management
Name positions that may be held by INS
Chief Nursing Informatics Officer (CNIO)
Chief Information Officer (CIO)
Director
In these roles they are visionaries & establish the direction of large-scale informatics solutions
Serves as a catalyst for developing strategic plans & creating national or system policies and procedures, while serving as a champion for integrated projects and systems
What are the Functional areas of NI?
Administration, Leadership, and Management
Name positions that may be held by INS in mid-level management
Supervise resources and activities for all phases of the SLC to include:
analysis
requirements gathering
design
development
selection and purchase
testing
implementation
evaluation of systems
supportWhat are the Functional areas of NI?
Systems Analysis and Design
Name the tools and resources that an NI would use to accomplish data aggregation
Data flow diagrams Entity-relationship modeling Taxonomies Clinical Vocabularies Quality indicators
What are the Functional areas of NI?
Systems Analysis and Design
Major responsibilities of the IN or INS
Understand workflow processes
Understand particular informatics solutions
Understand how these affect each other
enhances safety and reduce inefficiencies in a HC environment
What are the Functional areas of NI?
Systems Analysis and Design
Knowledge Discovery in Databases (KDD)
Using sound methodologies & practical evidence-based recommendations, the INS can discover information & knowledge related to diverse areas of nursing practice
What are the Functional areas of NI?
Systems Analysis and Design
What are some knowledge discovery in databases (KDD) methods?
Data mining
Machine learning methods
What are the Functional areas of NI?
Systems Analysis and Design
Analysis
Required for the use of clinical:
vocabularies
languages,
taxonomies
Nursing languages must be re-evaluated for their applicability and currency
What are the Functional areas of NI?
Systems Analysis and Design
Analysis of a meta-database
(such as Unified Medical language System [UMLS])
requires knowledge of nursing and medical vocabularies in order to analyze groups of taxonomies & map them to similar terms. (ex: SNOMED CT to ICD-10 CM) to aid in meeting & attesting to MU requirements
What are the Functional areas of NI?
Systems Analysis and Design
Outcomes analysis
r/t any domain of nursing practice:
clinical
education
research
administrationWhat are the Functional areas of NI?
Systems Analysis and Design
Analysis can include the use of human-computer interaction principals and methods. Name tools & methods that the IN or INS use to evaluate the match of systems to users, tasks, & contexts
Heuristics
Cognitive walk-through
Analysts use other tools to:
1-maintain data integrity & reliability
2-facilitate data aggregation & analysis
3-identify outcomes
4-identify organizational barriers
5-develop performance measures
These techniques allow nurses to contribute to building a knowledge base consisting of the data, information, theories, & models used by nurses and other stakeholders in decision-making that supports quality health care.
What are the Functional areas of NI?
Compliance and Integrity Management
Computerized information systems must support compliance with the 1996 HIPAA efforts by limiting access to personally identifiable health information to only those who require and are authorized access.
Auditing systems that detect red flags, reporting systems that will preserve confidentiality or anonymity, and enterprise risk management (ERM) allows reporting of risks by everyone in an organization.
What are the Functional areas of NI?
Compliance and Integrity Management
Enterprise Risk Management (ERM)
Breaks down silos
Provides timely reporting of risks and opportunities at a high level for immediate attention through risk scoring and mapping
What are the Functional areas of NI?
Compliance and Integrity Management
The IN and INS mush ave & maintain the knowledge to effectively apply current ethical standards and regulatory requirements to help HCO to:
- Revise operation procedures for staff
- Establish technical processes to maintain compliance
- Meet new regulatory mandates at local, state, national, and global levels
What are the Functional areas of NI?
Consultation
How are IN or INs consultants
Apply informatics knowledge & skills to serve as transformational leaders & resources for clients (formally & informally) in external & internal settings.
IN consultants are expected to have solid expertise in clinical nursing & areas such as:
process redesign
strategic IT planning
system implementation
writing for informatics & other publications
evaluating clinical software products
working w/clients to write requests for proposals
performing market research
assisting in the planning of conferences, academic courses, & prof development programs
What are the Functional areas of NI?
Consultation
Skills needed
Flexibility
Good communication skills
Solid nursing/healthcare delivery background
Breadth & depth of clinical and informatics knowledge
Excellent interpersonal skills
What are the Functional areas of NI?
Coordination, Facilitation, & Integration
Common role for NI is implementing informatics solutions
Nurses have well suited for IT implementation as it follows the nursing process of:
Assessment
Diagnosis
Outcomes Identification,
Planning
Implementation
Evaluation
In or INs may serve as a project coordinator, facilitating change management & integrating the info & technology to transform processes
What are the Functional areas of NI?
Coordination, Facilitation, & Integration
How do IN and INs serve as a hub?
Serve as a hub for interprofessional communication & as a bridge & communication liaison between & among informatics solution users, clinical & nonclinical end users, & IT experts and staff. Often serve as translators & integrators addressing system requirements & impacts
What are the Functional areas of NI?
Coordination, Facilitation, & Integration
What is the role of the IN or INs once the engineer has created a product
The IN or INs evaluates the use and usability of the product from the viewpoint of the end-user (liaison type of facilitation & coordination)
Also, ensures that integration of nursing vocabularies & standardized nomenclatures in applications
What are the Functional areas of NI?
Development of Systems, Products, & Resources
How is the IN or INs key to the above?
translates user requirements into effective informatics solutions.
Development activities include:
conceptualizing models for applications
software and hardware design
design of education manuals and media
design of complex technology networks
What are the Functional areas of NI?
Development of Systems, Products, & Resources
What are some of the functions that IN and INs participate in?
Process of design
Iterative development
Testing
Dissemination of quality informatics solutions for nurses, other hcp, and consumers
What are the Functional areas of NI?
Development of Systems, Products, & Resources
IN and INs must be knowledgable about standards requirements…what are some of these standards?
- Health Level Seven (HL7)
- International Organization for Standardization (ISO)
- Current Procedural Terminology (CPT)
- International Statistical Classification of Disease & Related Health Problems (ICD)
- Digital Imaging and Communications in Medicine (DICOM) group standards as well as
- Section 508 accessibility standards
What are the Functional areas of NI?
Development of Systems, Products, & Resources
Example
A developer employed by a PHR software vendor creates user-friendly screens for consumers to enter info as well as screens for nurses to display & interpret the data
What are the Functional areas of NI?
Administration, Leadership, and Management
Example
INS at a large hospital system supervising an implementation & education team, representing nursing interests on various IT committees, performing project management for multiple documentation projects, and having oversight of nursing standards and vocabularies used in applications.
What are the Functional areas of NI?
Systems Analysis & Design
Example
A nursing analyst in a hospice setting tracks health consumer data to establish a weighted case mix to determine nursing personnel allocations.
What are the Functional areas of NI?
Consultation
Example
The project coordinator for a statewide electronic health record implementation coordinates all aspects of the project and supervises an interdisciplinary team to prepare public health personnel to use the application.
What are the Functional areas of NI?
Education & Professional Development
What is the role of the IN or INs in education and professional development?
May directly affect the success or failure of any new or modified IT solution
Teaching about the effective and ethical uses of information technology, as well as NI concepts & theories, is essential for the optimal use of informatics solutions in nursing practice.
Continuing education is essential in the ever-changing requirements in healthcare information technology
What are the Functional areas of NI?
Education & Professional Development
What is the role of the IN or INs in education and professional development?
Educators and trainers assess & evaluate informatics skills and competencies while providing feedback to the learner regarding the effectiveness of the activity and the learner’s ability to demonstrate newly acquired skills.
Educators and trainers:
manage
evaluate
report
utilize data and information r/t specific learner & the educational delivery system
What are the Functional areas of NI?
Education & Professional Development
As NI innovators
- Define & develop educational technologies
- Integrate solutions into educational & practice enviorn
- Challenge organizations to consider & adopt innovative informatics solutions
