Lesson 2: Development of Health Informatics & Theoretical Framework in Nursing - PDF

Lesson 2 Development of The Health Informatics and Theoretical Framework in Nursing Profession Health Informatics Course NUR 351 Dr. Sally M.Farghaly  Objectives By the end of this lesson, students will be able to: Review the history of the developmen...

Lesson 2 Development of The Health Informatics and Theoretical Framework in Nursing Profession Health Informatics Course NUR 351 Dr. Sally M.Farghaly  Objectives By the end of this lesson, students will be able to: Review the history of the development of clinical informatics in the Nursing Profession. Determine the key concepts relating to clinical informatics. Discuss the key concepts relating to clinical informatics and information science. Recognize the Theoretical Framework of clinical informatics in healthcare. Discuss the need for Health Information Management.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Informatics in Nursing Practice Role of 21st century nurses is complex – Requires interaction with multiple medical devices and health IT – Increasingly likely to be involved in the design of new clinical systems Technology is integral to all parts of healthcare delivery for healthcare providers (HCPs), patients, and healthcare settings.  Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics Florence Nightingale has been recognized as an early informatics nurse because of her use of data to inform knowledge and change nursing practices. In 1863, Nightingale was clear in her desire to collect, retrieve and analyze data to be able to recognize trends in illnesses and treatments to improve the quality of care. It would take another century before nurses would begin to realize the benefits of integrating computer systems into their practice.  Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1950s and 1960s During the 1950s and 1960s the image of nurses was improving, nursing practices were growing in scope and complexity and nurses were expanding in number. Health care facilities increased in number and the nurses’ station started to be considered the center of communication activities and information exchange. As computer technologies advanced with the development of real-time processing and desktop terminals, research was conducted to determine how computers could be used most effectively in health care. During this time period, computers were used primarily in health care facilities for basic business, financial and accounting operations. Progress in developing clinically-based applications continued to be slow.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Prototypes  Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Transistors  Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Integrated circuits  Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Microcomputer; Windows  Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Internet; Web  Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Google  Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1970s Nursing staff began to recognize the value of integrating computer applications into their practices and processes, particularly for documenting care and the evaluation of the care delivered; as well as automating specific functions such as staff scheduling or statistics collection. Nurses became instrumental in the development of nursing applications for hospital information systems.  Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1980s The advent of the PCs with significantly improved computing power made computers more accessible and user-friendly for nursing and other health care professionals. Hospital information systems were increasing in functionality and use. The system documented several aspect of patient record, namely order entry evaluating the kardex, vital signs, narrative nursing notes , and discharge planning system used as referral to community health care facilities. Nursing informatics became a recognized specialty in the US and experts in the field were beginning to emerge – with job titles such as informatics nurse or nurse informatician.  Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1990s and beyond The technology revolution that was impacting all aspects of life did not leave health care untouched. 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 made it simpler for nursing and other health care professionals to access applications at the point-of-care – where the patient was. Computer technology becomes integral part of health care setting, nursing practice, and nursing profession. Policies and legislation were adopted and promoting computer in health care including nursing. Nursing informatics becomes approved by American Health Association (ANA) as a new nursing specialty.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Clinical Informatics Concepts Data o Collected information used to answer questions Information o Created by assembling data in a clinical context Knowledge o Concerns how data and information are used Wisdom o Use of knowledge to solve real-world problems  Development of The Health Informatics and Theoretical Framework in Nursing Profession Clinical Informatics Concepts Systems o Information systems Support the transfer from data to information. o Decision-support systems Support the transition from information to knowledge. o Expert systems Apply knowledge through wisdom. Informatics tools o Clinical guidelines, formal medical terminologies, computers, and information and communication systems Used to capture and present information.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics There are several theories that related to nursing informatics, which come from a variety of disciplines, and they are: 1. Change theories: A-Lewins change theories (planned change) Kurt Lewin's theorized a three-stage of change that requires prior learning to be rejected and replaced.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Unfreeze Refreeze Ensures that Ensures that the Execute the employees are ready change becomes intended change for change permanent Change  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Unfreezing: Unfreezing is the process which involves finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. An example is moving from a paper-based documentation system to an electronic system. Moving stage: During this stage, the plan change is implemented the change target groups are convinced that the new way is better than the old. This stage involves a process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Refreezing stage: Refreezing is establishing the change as a new habit, so that it now becomes the “standard operating procedure.” However, keep in mind that if the change is too strongly reinforced it is easy to backslide into the old ways of doing things. Rewards, support, and champion leadership continue to be important through this stage Lesson 2: Development of The Health Informatics and Theoretical Framework in Nursing Profession Bar-coded medication administration  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Rogers 'Diffusion of Innovation (unplanned change):  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Rogers 'Diffusion of Innovation (unplanned change): Rogers classified people into five groups based on their responses to change to view how innovations are accepted by general population: Innovators: These are the risk-takers who are the first to use the innovation. About 2.5% of the population falls into this group. Early adopters: This group tried to be influential because others look to them for opinion leadership and they serve as role models for others in the organization. They comprise about 13.5% of the population.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Rogers 'Diffusion of Innovation (unplanned change): Early majority: Makes 34% of the population. They adopt an innovation after a varying degree of time that is significantly longer than the innovators and early adopters. They may adopt to innovation not because they see a use for it, but because of peer pressure. Late majority: makes 34% they adopt an innovation after the average participant. These individuals approach an innovation with a high degree of skepticism and after the majority of society has adopted the innovation. Laggards: The last groups compromising 16% they are suspicious of innovation and change and are quite resistant. Laggards must be certain to adopt the change.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics 2. Systems Theory: This theory is built upon the following ideas : Change in one part of the system affects the entire system. In system theory the focus is the interaction among the various parts of the system instead of regarding each individual part as standing alone. Input into the system from the environment is processed within the system and becomes output back into the environment. There must be a built -in feedback mechanism.  Development of The Health Informatics and Theoretical Framework in Nursing Profession The Need for Health Information Management Impact of fragmentation – Fragmentation of care places patients at greater risk for poor outcomes, especially in regard to: Patients with multiple or chronic conditions Childhood immunizations Inaccurate or incomplete transfer of information related to patients transitions from inpatient to home care  Development of The Health Informatics and Theoretical Framework in Nursing Profession The Need for Health Information Management The promises of clinical informatics systems – Improved efficiency – Improving the health care of 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  Development of The Health Informatics and Theoretical Framework in Nursing Profession Challenges in clinical informatics Lack of system interoperability True healthcare interoperability involves people, processes, systems, information, communications, and more — all supported by a drive to deliver better healthcare. “A child got a duplicate chemotherapy dose due to fragmented recordkeeping systems.” Poor usability of health IT Inaccessible information led to inappropriate drug administration “Orders to hold a drug dose were inaccessible to nurses”  Development of The Health Informatics and Theoretical Framework in Nursing Profession Challenges in clinical informatics Failure to design health IT for human factors to prevent errors The patient had been started on a heparin infusion on one unit and then transferred to an other one. The order set for the heparin infusion was not entered properly, leaving out the automatic order for blood tests every 6 hours. During the handoff report, the nurses forgot to discuss this. Patient had been complaining of a headache for several hours. CT scan showed intracerebral hemorrhage.  Development of The Health Informatics and Theoretical Framework in Nursing Profession Health Informatics / Best Practice in 2005 Denmark 85% of health sector integrated within single system 2 million messages a month Central database of all prescriptions and all lab tests New Zealand 75% of health sector integrated 3 million messages a month Veterans Administration $21 billion, covering 25 million servicemen & families Highest score in every category of quality assessment in 2003 Care based on VISTA, enabling Continuous Quality Control Cost per patient static over last decade (all other US providers 50%) Summary Objectives Review the history of the development of clinical informatics in the Nursing Profession. Define and discuss key concepts relating to clinical informatics and information science. Recognize the Theoretical Framework of clinical informatics in healthcare. Discuss the need for Health Information Management. Why is nursing informatics (NI) vital to effective nursing practice in the 21st century? References 1. 1-Susan A, Karen H, and Frith H: Applied Clinical Informatics for nurses, (2019) 2nd ed. 9781284129250 128412925X. 2. 2- Altarum Institute (2017). Health sector economic indicators: Insights from monthly national health spending data through December 2016. Retrieved from http://altarum.org/sites/default/files/uploaded-related-files/CSHS-Spending- Brief_February_2017.pdf 3. 3- International Council of Nurses. (2015). International classification for nursing practice (ICNP) informationsheet. Retrieved from http://www.icn.ch/images/stories /documents/pillars/Practice/icnp/ICNP_FAQs.pdf References 4. Kaminski, J. (2015). Computer science and the foundation of knowledge model. In D. McGonigle & K. G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (2nd ed., pp. 33–56). Burlington, MA: Jones & Bartlett Learning. 5. 4- Karamali, M., Heidarzadeh, Z., Seifati, S. M., Samimi, M., Tabassi, Z., Hajijafari, M.,... Esmaillzadeh, A. (2015). Zinc supplementation and the effects of metabolic status in gestational diabetes: A randomized, double-blind placebo- controlled trial. Journal of Diabetes Complications, 29(3), 1314–1319 Thank You