Clinical Informatics in Nursing

Lesson Objectives

• Students will review the development of clinical informatics in nursing.
• Students will identify key concepts related to clinical informatics.
• Students will discuss key concepts related to clinical informatics and information science.
• Students will recognize the theoretical framework of clinical informatics in healthcare.
• Students will discuss the need for health information management.

Informatics in Nursing Practice

• The role of 21st-century nurses is complex.
• Nurses interact with multiple medical devices and health IT.
• Nurses are increasingly involved in designing new clinical systems.
• Technology is essential for all parts of healthcare delivery (healthcare providers, patients, and healthcare settings).

History of Nursing Informatics

• Florence Nightingale was an early informatics nurse, using data to inform and change nursing practices (1863).
• It took another century for nurses to integrate computer systems into their practice.

History of Nursing Informatics (1950s-1960s)

• The image of nurses improved during the 1950s and 1960s.
• Nursing practices expanded in scope and complexity.
• The number of nurses increased.
• Nurses' stations became central communication hubs.
• Computer technologies developed, leading to research on their use in healthcare.
• Computers were primarily used for business, financial, and accounting tasks in healthcare.

Computers (Timeline)

• 1950s: Prototypes
• 1960s: Transistors
• 1970s: Integrated circuits
• 1980s: Microcomputers; Windows
• 1990s: Internet; Web
• 2000s: Google

History of Nursing Informatics (1970s)

• Nurses recognized the value of integrating computer applications into their practices and processes.
• Documenting care, evaluating care, and automating functions (e.g., staff scheduling, statistics) became more common.
• Nurses played a crucial role in developing nursing applications for hospital information systems.

History of Nursing Informatics (1980s)

• Personal computers (PCs) with improved power became more accessible to nurses and other healthcare professionals.
• Hospital information systems (HIS) improved in functionality.
• Records (e.g., Kardex, vital signs, narrative notes, discharge plans) were increasingly documented in systems.
• Nursing informatics emerged as a recognized specialty in the US.

History of Nursing Informatics (1990s and Beyond)

• Computer technology significantly impacted healthcare.
• Computers became smaller, faster, and easier to use.
• The internet became a tool for web-based clinical applications, communication, and access to evidence-based resources.
• Wireless technologies facilitated point-of-care access to applications.
• Nursing informatics became approved as a new nursing specialty by the American Health Association (ANA).

Clinical Informatics Concepts

• Data: Collected information used to answer questions.
• Information: Data assembled in a clinical context.
• Knowledge: Understanding how data and information are used.
• Wisdom: Using knowledge to solve real-world problems.

Clinical Informatics Concepts (Systems)

• Information systems: Support transferring data to information.
• Decision-support systems: Support transition from information to knowledge.
• Expert systems: Apply knowledge through wisdom.
• Informatics tools: Clinical guidelines, medical terminologies, computers, information and communication systems—used to capture and present information.

Theories in Nursing Informatics (1)

• Change theories (Lewin):
  • Kurt Lewin's theory involves three stages: Unfreezing, Change, and Refreezing.
  • Unfreezing involves preparing for change.
  • Change involves implementing the intended change.
  • Refreezing involves making the change permanent.

Theories in Nursing Informatics (2)

• Unfreezing: Addressing issues that hinder change; an example includes switching from paper-based documentation to electronic documentation.
• Moving stage: The change happens; all parties involved are convinced the new way is better than the old.
• Refreezing stage: The change is now standard operating procedure. Reinforcing the change is crucial to prevent backsliding.

Theories in Nursing Informatics (3)

• Rogers' Diffusion of Innovation:
  • Categorizing those who adopt innovations (Innovators, Early Adopters, Early Majority, Late Majority, and Laggards).
  • Identifying those who adopt innovations quickly and others who approach innovations with skepticism (Innovators, Early adopters, Early Majority, Late Majority, Laggards).

The Need for Health Information Management

• Impact of fragmentation: Patients with multiple or chronic conditions, childhood immunizations, and transfers from inpatient to home care pose risks for poor outcomes.
• Promises of clinical informatics systems: Improved efficiency and better care for older adults.
• Challenges in clinical informatics:
  • Lack of system interoperability.
  • Poor usability of health IT.
  • Failure to design health IT for human factors to prevent errors

Challenges in Clinical Informatics (Examples)

• Lack of system interoperability: Problems like patients receiving duplicate chemotherapy doses.
• Poor usability of health IT: Inaccessible information leading to inappropriate drug administrations, for example, nurses being unable to access drug dose information.
• Failure to design health IT for human factors: Errors in data entry, handoff processes, and lack of consideration for human behavior contributing to patient care errors, such as missing vital information due to a lack of a detailed handover.

Health Informatics / Best Practice (2005)

• Countries like Denmark and New Zealand showed strong integration of health sectors within their single systems.

Summary

• The objectives were to review the history of clinical informatics, explain key concepts, and recognize the theoretical framework in healthcare.
• Discuss the need for health information management. Explain why nursing informatics is key to effective 21st-century nursing.

This quiz explores the development and key concepts of clinical informatics within the nursing profession. Students will learn about the historical evolution of nursing informatics, the role of technology, and the importance of health information management in improving patient care. Engage with theories and practices relevant to modern nursing informatics.