Professional Documents
Culture Documents
Introduction
Ball (2000) stated that 'The strength of nursing profession depends on its
ability to take advantage of the best that technology can offer'. Therefore,
preparing nurses to face the information challenges of the future requires a solid
grounding in information sciences. Simply teaching computer applications in
nursing will provide nurses with the skills to critically appraise their information
needs and utilization of gathering information in patient care (Romano, 1985;
Hannah et al., 1994). Providers of health care as nurses depend on accurate
information in order to accommodate future changes at the lowest possible costs.
Community-based nursing refers to both the setting and the practice of the
nursing role. Nursing care that occurs in a setting other than acute care; also
referred to as community health nursing. Population-and community-focused care
Nursing Informatics and its Application to Community Health Nursing 2
effectiveness and efficiency of health care and empower clients to make health
care choices which contribute to the advancing of the community health nursing
science. Nursing informatics can be accomplished using information structures,
information processes, and information technology (McGuire, 2001).
Data are discrete observations that are not interpreted, organized, or structured.
Data mining technology was defined by Berry and Linhoff (1997) as “the
semiautomatic exploration and analysis of large quantities of data in order to
discover meaningful patterns and rules.” The identification of meaningful patterns
in data has always been an integral part of scientific discovery, since patterns are
necessary for the construction of scientific hypotheses and causal models
(Brossette, 1998). Data mining as a method for data analysis in nursing research
can contribute to the discovery of causal factors and demonstrate outcome
effectiveness. It is a technology that can turn massive amounts of raw data into
useful information that can improve clinical nursing practice.
Examples of Knowledge
● Referral systems protocols
● Care plans for specific health problem
●Relationship between different nursing
interventions and client outcomes.
While the concepts of data, information, and knowledge are different, the
concepts as a whole are typically referred to generically as information. All the
three concepts are stored in computers and software programs be developed to
assist in the interpretation of the data and the development of nursing knowledge.
Lyman and Varian (2000) stated that the world’s total annual production of
information amounts to approximate Mega Bytes (MB) for each man, woman,
child on earth, and that number is expected to double every year for foreseeable
future. Ninety-three percent of the information that is currently produced each
year is now stored in digital. Increased computing power, decreasing costs, and
advances in data capture and storage technologies have resulted in massive data
sets in many disciplines, including nursing.
Knowledge-Based Services
Knowledge networks not only allow scholars and scientists to work
together more effectively, across distance, but also offer completely new
approaches to investigating and analyzing concepts and phenomena. Knowledge
Discovery in Databases (KDD) is a process that includes data selection, data
Nursing Informatics and its Application to Community Health Nursing 6
• help health care professionals acquire and maintain the knowledge and
skills they need to care for clients/patients
• support clinical and management decision-making (computerized decision
support systems should be developed for nurses and decision makers).
• support performance improvement
• satisfy research-related needs
• educate clients/patients and families
with common definitions for common terms to enable the effective management
and processing of data. Over the last decade, there has been significant progress
in development of health information concepts and standards.
Security; it refers to the procedures and technologies that are used to restrict
access to, and maintain the integrity of health information. McGuire (2001) stated
that the establishment of various standards related to privacy, confidentiality and
security have evolved over the years. Finally, in implementing operational
guidelines, various procedures and security systems are used; each is based on
specific technical standards.
McGuire (2001) mentioned that there are too many technical standards
related to information systems security to be done, and explains some examples
that are relevant to nurses such as:
● Identification (e.g., passwords) and authentication (e.g., digital signature) of
users of health information.
● Provision of audit trails or records of access activity relating to health
information.
● Protection from unauthorized access (e.g., firewall) to health information.
In 1981, the Council of Europe enacted its Convention for the Protection of
Individuals with regard to automatic processing of personal data. Data should be:
With the atmosphere of uncertainty about data protection, Tom and Frank
(2004) stated that there is a threat to informatics research in primary care and it
should serve as an extra motivation for community nurses to develop effective
ethical processes for managing information that justify the trust of the
community. Uncertainty is a challenge, but a positive response to that challenge
will bring a stronger system for managing individual data in health researches.
Code of ethics and legality for Electronic Health (e-health) were developed
by Mediterranean Region Countries through the World health Organization
(2004) about the following topics: definitions, confidentiality, honesty, quality,
sustainability, privacy, sharing, and accountability of the electronic health
(Appendix ◄1► Arabic Version).
In the Eastern Mediterranean region, nurses have also laid some important
groundwork for cross border cooperation in regulation. There is reported to be a
wide variation in regulatory laws, policies and practices governing nursing in this
region, and the goals of current activity include one relating to inter-linked or
integrated systems for registration and licensing. Standards for nursing education
and prototype criteria have been developed, with support from both ICN and
WHO.
Clinical Practice
● Recording of client assessment data in an electronic health record
● Recording of workload and interventions as a by-product of electronic charting
(software).
Nursing Informatics and its Application to Community Health Nursing 12
Education
● Distance learning/teaching via the internet
● Recording of workload and interventions as a by-product of electronic charting
(software)
Research
● Evaluation of nurse-sensitive outcomes measures using a standard minimum
data set
● Use of knowledge bases via the internet
● Recording of workload and interventions as a by-product of electronic charting
(software).
Physical Infrastructure/Architecture
The infrastructure consists of both the telecommunication media used to
actually transmitting information—such as phone lines, fiber-optic cables,
satellites, and microwave systems—and the media used as input/output devices—
such as telephones, video cameras, monitors, fax machines, and computers—that
are needed to send and receive data. One set of media cannot be used without the
other in informatics but various combinations of use are essential.
Governments must have the will and the fiscal objectives to resource the
necessary telecommunication infrastructure for their citizens irrespective of
location. In addition, the information and telecommunication technology
infrastructure needs to be accommodated with many and varied applications
which required for the support of rural and remote communities. The
disadvantaged in rural and remote areas can benefit significantly from these
technologies. This is feasible only when the technologies can be fully utilized for
a variety of purposes.
and from nurses. Also providing library materials on client care units is another
issue to encourage the development of computer skills. Nursing journals, such as
Computer in Nursing, basic computer books, periodicals, or manuals can provide
basic, useful news for nursing staff.
How can nurses prepare themselves for computerization at work, and how
can health care organizations facilitate this transition? This is a critical question
when the majority of nurses in Egypt has had no experience with computers or
feels uncomfortable and intimidated by them. The focus now is on the computer’s
need for input data. If we are serious about designing computers to support nurses
in the care of clients, more effort needs to be made to change how these data are
being collected and accessed. This change should focus on the nurse’s need to
collect and retrieve data as quickly and easily as possible. It also fosters
communication among the members of the healthcare team.
Communication
Communication
Change Process
Change Process
Time Frame
Time Frame
Leadership
Leadership
Training Software
Training Software
Figure (1) showed the factors for designing computer educational programs
(Adaskin et al., 1994).
This figure shows the support of administration in the center of the wheel
as leadership. Strong leadership, planned changes, effective communication,
special software, established time frames, and a carefully planned training process
can yield success in implementing a nursing information system.
The second step of the process involves changing or moving to a new level.
It is here that the actual change occurs and the driving forces have equalized or
Nursing Informatics and its Application to Community Health Nursing 19
overcome the restraining forces. The nurse informaticist has gathered the
necessary information to move forward with the proposed change. A detailed plan
is constructed for implementing the change, and the change is executed within the
organization. In the final step of Lewin’s process, refreezing, the change is
stabilized at the new level within the organization. The nurse informatics assist
with maintenance and evaluation as functions stabilize and the change is
incorporated into the system.
Database Mining
Data mining is a powerful tool in the knowledge discovery process that can
now be done with a number of open-source software packages. It is a tool that has
the potential to expand the scope of inquiry by opening up the realms of health
care data available in large databases (Computers Informatics Nursing, 4004). In
addition, data mining as a method for data analysis in nursing research can
contribute to the discovery of causal factors and demonstrate outcome
effectiveness.
The database has two main aims as stated by Hippisely-Cox, Stables and
Pringle (2004) the first is to provide very good access to high- quality validated
data for use in ethical research. The second aim is for QRESEARCH such as
surveys that make morbidity statistic available to health community at large.
— Educating the populace about the role of life-style choices and client
behavior in health promotion and prevention of disease and injury are basic
community health functions (Friede, Blum and McDonald,1995).
— Long term care settings such as nursing homes and other health care
institutions have found it difficult to manage the regulatory process and provide
quality health care without computerized clinical information systems (Zielstorff,
1998).
Cowley, Dawa and Ellis (2003) said that “If primary care is to rise to the
challenge, the primary care team needs to be supported by tools and
methodologies that enable it to reflect on, and improve, the quality of the service
it provides within the context of an already demanding schedule.
Informatics has been used in the medical field for about 30 years, but the
public health community has embraced it only recently, since the early 1990s,
Communicable Disease Control (CDC) has been working with other federal
health agencies, state and local governments, professional associations, and the
health care informatics community to advance its use. Examples of informatics
activities include integration (linking together a wide variety of surveillance
activities), standardization (developing and using detailed standards for data
elements required to support public health surveillance), and information
dissemination (using the Internet to dynamically generate and disseminate
information). Each of these strategies improves the timeliness, completeness, and
accessibility of public health data (Zlot 2001).
“I like to think of community health informatics as more than the sum of its
parts,” said Zlot (2001) discussing why people often have difficulty
understanding what it involves and why it is important. She explained that public
health informatics combines various disciplines— public health science,
computer science, information technology, cognitive science, education,
management, economics, and even political science and anthropology— to ensure
that public health data are easy to access, analyze, and communicate, and are used
appropriately.
Experienced Nurse
• Has proficiency in a domain of interest (e.g., public health, education, administration).
• Highly skilled in using information management and computer technology skills to support his/her
major area of practice.
• Sees relationships among data elements and makes judgments based on trends and patterns within
these data.
• Uses current information systems but collaborates with the informatics nurse specials to suggest
improvement to systems.
Informatics Nurse Specialist
• An RN with advanced preparation possessing additional knowledge and skills specific to
information management and computer technology.
• Focuses on information needs for the practice of nursing, which includes education, administration,
research, and clinical practice.
• Uses the tools of critical thinking, process skills, data management skills (including, acquiring,
preserving, retrieving, aggregating, analyzing, and transmitting data), systems development life cycle,
and computer skills.
Informatics Innovator
• Educationally prepared to conduct informatics research and generate informatics theory.
• Has a vision of what is possible and a keen sense of timing to make things happen.
• Leads the advancement of informatics practice and research.
• Functions with an ongoing healthy skepticism of existing data management practices and is creative
in developing solutions.
• Possesses a sophisticated level of understanding and skills in information management and computer
technology
• Understands the interdependence of systems, discipline, and outcomes, and can finesses situations to o
maximize outcomes.
I. New Clinician
• Computer literacy
• Information literacy
• Web literacy
• Identify, collect, record relevant data
• Analyze and interpret nursing information
• Use application designed for nursing practice
• Protect privacy of health information.
1. Front Line staff: nurses who carry out the bulk of day-to-day tasks
(e.g., nurses, counselors, investigators, lab technicians, health
educators, and other clinicians). Responsibilities may include basic
data collection and analysis, fieldwork, program planning, outreach
activities, programmatic support, and other organizational tasks.
2. Senior level staff (Senior Level Technical Staff): nurses with a
specialized staff function but not serving as managers (e.g.,
epidemiologists, biostatisticians, health planners, health policy
analysis). They have increased technical knowledge of principles in
areas such as epidemiology, program planning, and evaluation, data
collection, budget development, grant writing, etc., and may be
responsible for coordination and/or oversight of pieces of projects or
programs.
3. Supervisory and management staff: nurses for major programs or
functions of an organization, with staff who report to them. Increased
skills can be expected in program development, program
implementation, program evaluation, community relations, writing,
public speaking, managing timelines and work plans, presenting
arguments and recommendations on policy issues.
Maddux (2001) notes that college students of any discipline are now
enticed by marketing that offers online “bachelor’s, master’s, or doctoral degrees
in nursing sciences in 12 months without mandatory attendance in structured
classroom settings”. Undergraduate and graduate degrees in nursing can be
obtained via the internet through the Web sites of colleges and universities.
Peterson, Hennig, Dow and Sole (2001) pointed out different internet
teaching methods for nursing education as; (a) using handheld computers, (b)
using the Internet for clinical instruction, (c) facilitating synchronous and
asynchronous online discussions, (d) assessing health needs on another continent
via the Internet, (e) designing Internet Journal discussions, (f) identifying Internet
surveys research opportunities for students, (g) teaching pathophysiology through
online discussion boards, and (h) using e-mail to develop nursing scholarship.
supplying services. A Foreign Service provider can choose the model best suited
to its needs and interests. These four models were discussed and presented as:
1- Cross border, where for example a university in one country
provide education services to citizens of another country;
2- Commercial presence, where for example a U.S. health
organization operates a hospital in another country;
3- Consumption abroad, for example citizens of one country
purchase health services in another country; and
4- Movement of natural persons, for example nurse migration to
other countries to provide nursing services.
For nursing, Shaw (2002) mentioned that all of these models have
implications for the provision and quality of nursing services. However, it is the
fourth model, movement of natural persons, subsequent work has to be done in
relation to areas as technical standards, licensing, education and qualifications.
Nursing and other health professionals, need to consider the following points in
relation to the globalization of health professional regulation (ICN, 2004);
─ Specialty and advanced nursing practice. Nursing has paid little
attention to cross border recognition of this. Many programs are still
in early stages of development.
Summary
Nursing Informatics can be viewed through a number of different lenses.
The most common ones include the standard areas of nursing: nursing practice,
nursing education, nursing research, and nursing administration. Nursing
Informatics can also be viewed through the sociological lens of empowerment,
dialogue, synthesis, and creative expression.
Recommendations
Based on this state-of art article of the “Nursing Informatics and Its
Application to Community Health Nursing” the following are
recommendations concerning this area of nursing informatics:
Nursing Informatics and its Application to Community Health Nursing 35
─ The focus is now on the computer’s need for input data. Designing and
developing computers software programs are urgent needed to support
nurses in the care of clients, more effort needs to be made to change how
clients data are being collected and accessed. This change should focus on
the nurse’s need to collect and retrieve data as quickly and easily as
possible.
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