Nursing Informatics

According to Darvish, Bahramnezhad, Keyhanian, and Navidhamidi that the

competency of nursing informatics specialists was determined through studying three
categories including computer skills, informatics knowledge and informatics skills. It
investigates four levels of nursing practice: beginning nurse, experienced nurse,
informatics specialist, and informatics innovator.
Computer Skills – Selected computer skill competencies contain computerized searches
and retrieving patient demographics data, the use of telecommunication devices, the
documentation of patient care, the use of information technologies for improving nursing
care, and the use of networks and computer technology safely.
Informatics Knowledge – Selected informatics knowledge competencies are the
recognition of the use or importance of nursing data for improving practice, and the
recognition of the fact that the computer can only facilitate nursing care and that there
are human functions that cannot be performed by computers, the formulation of ethical
decisions in computing, the recognition of the value of clinicians’ involvement in the
design, selection, implementation, and evaluation of systems in health care, the
description of the present manual systems, the definition of the impact of computerized
information management on the role of the nurse and the determination of the
limitations and the reliability of computerized patient monitoring systems.
Informatics Skills – Informatics skills competencies includes the interpretation of
information flow within the organization, the preparation of process information flow
charts for all aspects of clinical systems, the development of standards and database
structures to facilitate clinical care, education, administration, or research. It also
includes the development of innovative and analytic techniques for scientific inquiry in
nursing informatics and new data organizing methods and research designs with the
aim of examining the impacts of computer technology on nursing, and the conducting of
basic science research to support the theoretical development of informatics.
Information literacy skills, competencies, and knowledge are investigated among
educators, administrators, and clinicians of nursing groups nationally.
According to Jeungok Choi and Jean E De Martinis that the students in both
programmed were competent in three subscale areas: basic computer knowledge and
skills, clinical informatics attitude, and wireless device skills. Graduate students reported
slightly higher mean competency scores than did undergraduate students in three
subscales: clinical informatics role, clinical informatics attitude and wireless device
skills.
Findings indicate specific topics for nurse educators to consider when designing
informatics curricula. The comparison of undergraduate and graduate students indicates
similarities in informatics competencies in terms of areas where students were
competent and small mean score differences. Further studies are suggested to examine
whether there are differences in informatics competencies between undergraduate and
graduate students.
According to Cummis, et.al. that the pathway to certification is clear and well-
established for U.S. based informatics nurses. The motivation for obtaining and
maintaining nursing informatics certification appears to be stronger for nurses who do
not have an advanced informatics degree. The primary difference between nursing and
physician certification pathways relates to the requirement of formal training and level of
informatics practice. Nurse informatics certification requires no formal education or
training and verifies knowledge and skill at a more basic level. Physician informatics
certification validates informatics knowledge and skill at a more advanced level;
currently this requires documentation of practice and experience in clinical informatics
and in the future will require successful completion of an accredited two-year fellowship
in clinical informatics. For the profession of nursing, a graduate degree in nursing or
biomedical informatics validates specialty knowledge at a level more comparable to the
physician certification. As the field of informatics and its professional organization
structures mature, a common certification pathway may be appropriate. Nurses,
physicians, and other healthcare professionals with informatics training and certification
are needed to contribute their expertise in clinical operations, teaching, research, and
executive leadership.
According to Gee et. al. the availability of health information on the Internet has
equalized opportunities for knowledge between patients and their health care providers,
creating a new phenomenon called the e-patient. E-patients use technology to actively
participate in their health care and assume higher levels of responsibility for their own
health and wellness. This phenomenon has implications for nursing informatics
research related to e-patients and potential collaboration with practitioners in developing
a collective wisdom. Nursing informatics can use the data, information, knowledge, and
wisdom (DIKW) framework to understand how e-patients and clinicians may achieve
this collective wisdom. Nurse informaticists can use constructivism and Gadamerian
hermeneutics to bridge each stage of this framework to illustrate the fundamentals of
patient and clinician interactions and commonality of language to achieve a collective
wisdom. Examining the e-patient phenomenon will help nurse informaticists evaluate,
design, develop, and determine the effectiveness of information systems used by e-
patients. The Internet can facilitate a partnership between the patient and clinician and
cultivate a collective wisdom, enhanced by collaboration between nurse informatics and
e-patients.
According to Desjardins et. al. that the Professional clinical societies, educational
accreditation organizations, and informatics associations have initiated activities and, in
some instances, guidelines or criteria for informatics competencies for clinicians,
informatics specialists, and informatics innovators. In addition, reports, such as that of
the Pew Health Professions Commission and the Institute of Medicine have identified
effective and appropriate use of information and communication technologies as an
essential competency for all health care professionals.

Patient Safety
According to Vincent that the plans for improving safety in medical care often
ignore the patient's perspective. The active role of patients in their care should be
recognised and encouraged. Patients have a key role to play in helping to reach an
accurate diagnosis, in deciding about appropriate treatment, in choosing an
experienced and safe provider, in ensuring that treatment is appropriately administered,
monitored and adhered to, and in identifying adverse events and taking appropriate
action. They may experience considerable psychological trauma both as a result of an
adverse outcome and through the way the incident is managed. If a medical injury
occurs it is important to listen to the patient and/or the family, acknowledge the damage,
give an honest and open explanation and an apology, ask about emotional trauma and
anxieties about future treatment, and provide practical and financial help quickly.
According to Emanuel, et. al. that the field of patient safety has emerged in
response to a high prevalence of avoidable adverse events. However, many do not use
a clear definition or have a clear model of understanding of the field. We call on
organizations to adopt a definition and model for patient safety. To assist the process,
we provide a definition and describe the nature of the field by going through each
component in the definition. We identify its primary focus of action as the microsystem
and its essential mechanisms as high-reliability design and the use of safety sciences
and other methods for causing improvement, including cultural change. We describe
key attributes of those who practice safety, and we identify its practitioners as all
involved in health care. To provide an easy-to-recall, overarching model of patient
safety, we offer one that identifies four main domains of patient safety (1) people who
receive health care, (2) people who provide it, (3) systems of therapeutic action and (4)
methods and elements within each domain. We hope that this description, definition,
and model will assist the integration of patient safety practices throughout health care.
According to Shojania, et. al. said that the practices with the strongest supporting
evidence are generally clinical interventions that decrease the risks associated with
hospitalization, critical care, or surgery. Many patient safety practices drawn primarily
from nonmedical fields (e.g., use of simulators, bar coding, computerized physician
order entry, crew resource management) deserve additional research to elucidate their
value in the health care environment. The following 11 practices were rated most highly
in terms of strength of the evidence supporting more widespread implementation.
Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk;
Use of perioperative beta-blockers in appropriate patients to prevent perioperative
morbidity and mortality; Use of maximum sterile barriers while placing central
intravenous catheters to prevent infections; Appropriate use of antibiotic prophylaxis in
surgical patients to prevent postoperative infections; Asking that patients recall and
restate what they have been told during the informed consent process; Continuous
aspiration of subglottic secretions (CASS) to prevent ventilator-associated pneumonia;
Use of pressure relieving bedding materials to prevent pressure ulcers; Use of real-time
ultrasound guidance during central line insertion to prevent complications; Patient self-
management for warfarin (Coumadin) to achieve appropriate outpatient anticoagulation
and prevent complications; Appropriate provision of nutrition, with a particular emphasis
on early enteral nutrition in critically ill and surgical patients; and Use of antibiotic-
impregnated central venous catheters to prevent catheter-related infections.
An evidence-based approach can help identify practices that are likely to improve
patient safety. Such practices target a diverse array of safety problems. Further
research is needed to fill the substantial gaps in the evidentiary base, particularly with
regard to the generalizability of patient safety practices heretofore tested only in limited
settings and to promising practices drawn from industries outside of health care.
According Nieva and Sorra that the healthcare organizations are becoming
aware of the importance of transforming organizational culture in order to improve
patient safety. Growing interest in safety culture has been accompanied by the need for
assessment tools focused on the cultural aspects of patient safety improvement efforts.
This paper discusses the use of safety culture assessment as a tool for improving
patient safety. It describes the characteristics of culture assessment tools presently
available and discusses their current and potential uses, including brief examples from
healthcare organizations that have undertaken such assessments. The paper also
highlights critical processes that healthcare organizations need to consider when
deciding to use these tools.
According to Battles and Lilford that the patient safety has become an
international priority with major research programmes being carried out in the USA, UK,
and elsewhere. The challenge is how to organize research efforts that will produce the
greatest yield in making health care safer for patients. Patient safety research initiatives
can be considered in three different stages: (1) identification of the risks and hazards;
(2) design, implementation, and evaluation of patient safety practices; and (3)
maintaining vigilance to ensure that a safe environment continues and patient safety
cultures remain in place. Clearly, different research methods and approaches are
needed at each of the different stages of the continuum. A number of research
approaches can be used at stage 1 to identify risks and hazards including the use of
medical records and administrative record review, event reporting, direct observation,
process mapping, focus groups, probabilistic risk assessment, and safety culture
assessment. No single method can be universally applied to identify risks and hazards
in patient safety. Rather, multiple approaches using combinations of these methods
should be used to increase identification of risks and hazards of health care associated
injury or harm to patients.
References:
Battles, J. B., & Lilford, R. J. (2003). Organizing patient safety research to identify risks
and hazards. BMJ Quality & Safety, 12(suppl 2), ii2-ii7. Retrieved March 22,
2023 from https://qualitysafety.bmj.com/content/12/suppl_2/ii2.short
Choi, J., & De Martinis, J. E. (2013). Nursing informatics competencies: assessment of
undergraduate and graduate nursing students. Journal of Clinical Nursing, 22(13-
14), 1970-1976. Retrieved March 21, 2023 from
https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.12188
Cummins, M. R., Gundlapalli, A. V., Murray, P., Park, H. A., & Lehmann, C. U. (2016).
Nursing informatics certification worldwide: history, pathway, roles, and
motivation. Yearbook of medical informatics, 25(01), 264-271. Retrieved March
21, 2023 from
https://www.thieme-connect.com/products/ejournals/abstract/10.15265/IY-2016-
039
Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of
nursing informatics on promoting quality of health care and the need for
appropriate education. Global journal of health science, 6(6), 11. Retrieved
March 21, 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825491/
Desjardins, K. S., Cook, S. S., Jenkins, M., & Bakken, S. (2005). Effect of an informatics
for evidence-based practice curriculum on nursing informatics competencies.
International Journal of Medical Informatics, 74(11-12), 1012-1020. Retrieved
March 21, 2023 from
https://www.sciencedirect.com/science/article/abs/pii/S138650560500105X
Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., ... & Walton, M.
(2009). What exactly is patient safety?. Journal of Medical Regulation, 95(1), 13-
24. Retrieved March 22, 2023 from
https://meridian.allenpress.com/jmr/article/95/1/13/438453/What-Exactly-Is-
Patient-Safety
Gee, P. M., Greenwood, D. A., Kim, K. K., Perez, S. L., Staggers, N., & DeVon, H. A.
(2012). Exploration of the e-patient phenomenon in nursing informatics. Nursing
Outlook, 60(4), e9-e16. Retrieved March 21, 2023 from
https://www.sciencedirect.com/science/article/abs/pii/S0029655411003587
Nieva, V. F., & Sorra, J. (2003). Safety culture assessment: a tool for improving patient
safety in healthcare organizations. BMJ quality & safety, 12(suppl 2), ii17-ii23.
 Retrieved March 22, 2023 from
https://qualitysafety.bmj.com/content/12/suppl_2/ii17.short
Shojania, K. G., Duncan, B. W., McDonald, K. M., Wachter, R. M., & Markowitz, A. J.
(2001). Making health care safer: a critical analysis of patient safety practices.
Evidence report/technology assessment (Summary), (43), i-x.
Vincent, C. (2011). Patient safety. John Wiley & Sons. Retrieved March 22, 2023 from
https://qualitysafety.bmj.com/content/11/1/76.short