LECTURE NOTES NURSING INFORMATICS (NSC371)

Nursing and Nursing Informatics

The nursing profession is rapidly changing to keep up with advancements and new
challenges in the healthcare field. As direct caregivers, nurses are in the frontline of
patient care and consequently often feel the impact of changes in best practices more
immediately than other healthcare professionals. In nursing as with healthcare in
general, informatics is becoming a tool to enhancing delivery of quality healthcare
care services. It is now used to address the challenges of the day, significantly
impacting the process of nurse’s documentation, monitoring, management and
retrieving of patient data.
Nursing is a field where patient-centered care is a top priority. To enhance patient
satisfaction with care, nurses need communication technology to facilitate care,
coordinate care, manage data, improve and analyze outcomes of care. They utilize
communication technology to access information for evidence-based practice and
use electronic records to improve care. As digitally connected health continues to
transform practice, nurses as the cornerstone of the healthcare system must develop
nursing informatics specific knowledge to ensure they can practice and think
critically in complex environments that rely on ICT. It is also important that nurses
adapt their practice in ways that are complemented by emerging technologies and
develop models of care that fit in digitally connected health environments to
maintain the core caring values of nursing (Abdrbo, 2015; Camilli, 2014). Just as
ICT use and digitally oriented healthcare are becoming integral parts of nursing
practice, nursing informatics knowledge has become integral to evolving nursing
care practice.
What is Nursing Informatics?
 A classic definition by Graves and Corcoran (1989) define Nursing
informatics “as a combination of computer science, information science and
nursing science designed to assist in the management and processing of
nursing data, information and knowledge to support the practice of nursing
and the delivery of nursing care”. This definition is important because it
highlights the multidisciplinary nature of nursing informatics and clearly
indicates that the goal of nursing informatics is the delivery of nursing care.

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 This definition is the core of recent publications by the American Nurses’
Association
 ANA (1992) expanded the previous definition by incorporating the role of
the informatics nurse specialist into Graves and Corcoran definition: ANA
defines NI as “A specialty that integrates nursing science, computer science,
and information science in identifying, collecting, processing and managing
data and information to support nursing practice, administration, education
and research and to expand nursing knowledge”. The purpose of nursing
informatics according to ANA is to analyze information requirements, design,
implement and evaluate information systems and data structures that support
nursing; and identify and apply computer technologies for nursing.
 Hannah, Ball and Edwards (1994), defined nursing informatics as: “the use of
information technologies in relation to those functions within the purview of
nursing and that are carried out by nurses when performing their duties”.
Therefore, any use of information technologies by nurses in relation to the
care of their patients, the administration of healthcare facilities or the
educational preparation of individuals to practice the discipline is considered
nursing informatics.
 ANA (2015) updated the definition of nursing informatics (NI) and defined it
as “the specialty that integrates nursing science with multiple information and
analytical sciences to identify, define, manage and communicate data,
information, knowledge and wisdom in nursing practice.
 Staggers and Thompson posit that the goal of NI is to improve the health of
populations, communities, families, and individuals by optimizing
information management and communication. These activities include the
design and use of informatics solutions and/or technology to support all areas
of nursing, including but not limited to, the direct provision of care,
establishing effective administrative systems, designing useful decision
support systems, managing and delivering educational experiences,
enhancing supporting lifelong learning and, supporting nursing research”.
Brief historical perspective of Nursing Informatics
Informatics is modelled after the French word informatique and was first used as a
medical informatics in the late 1970s. Healthcare system began to use computers in
the 1950s where computers were typically used in the business office. Nursing

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informatics as a field emerged from the overarching discipline of health informatics
and alongside the expanding field of medical informatics. In the 1970s, nursing
began to realize the importance of computers to the nursing profession and became
involved in the design and purchase of information systems. In the 1980s, medical
and nursing informatics specialties emerged. Personal computers were introduced
which allowed for flexibility in how these clinical systems were used. It also brought
to everyone‘s attention that not just NI specialist are to use computers but all
healthcare personnel. The first certification for NI was taken in 1995. The post-2000
era saw an unprecedented explosion in the number and sophistication of both
computer hardware and software. Electronic patient records became an integral part
of clinical information systems. Telemedicine became possible and was recognized
as a specialty in the late 1990s.
From the period it was introduced, NI has experienced rapid growth particularly in
the last 40 years and it does not appear to be slowing. It will be interesting to see
what will happen over the next 40 years (NOUN, 2020). At present, NI is a field of
study which is still developing and is based on the concept that health care data and
information can be effectively managed and communicated using computer systems,
networks, modems and tele-communications. The ANA designated nursing
informatics as a specialty practice in 1992. Subsequently, volunteer ANA members
have developed a scope and standards for practice, which serves as guides for the
practice (NOUN, 2020).

Notable Milestones in the historical development of NI

Prior to 1960s - Simple Beginnings
The use of computers in both computer and medical industry grew on early 1950s.
There were only few experts who formed a cadre of pioneers that attempted to adapt
computers to healthcare. During this time, the image of nursing profession was
undergoing major changes: improving nursing image, expansion of scope and
complexity of nursing practice and services and the increasing number of new
nurses. Initially, computers were used in health care facilities for basic business
office transactions. Some examples are punch cards to store data and card readers

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for computer programs, sorting and preparation of data for processing. They were
linked together and operated by paper tape and used teletypewriters to print their
output. As computer technology advanced, healthcare technologies improved.

1960s - Issues and NI Researches

The use of computer technology in healthcare settings began to be questioned. Areas
of debate were centered on the application of computers and data that needs to be
computerized. Nursing standards were reviewed and resources were analyzed.
Studies were conducted to assess computer technology and its effective utilization
in the healthcare industry. Nurses’ stations were considered as “hub” of information
exchange. The increasing number of healthcare facilities was paralleled to the
advancement in computer technology. The introduction of new computer
technologies such as the Cathode Ray Tubes (CRT) added more dimensions to
computer systems providing more accessible and user-friendly machines.

Hospital Information Systems (HISs) were primarily developed to process financial

transactions but few emerged to document and process healthcare activities.
Computer vendors were beginning to penetrate the healthcare field but the progress
was slow due to limitations in technology, lack of standardization and diversity in
paper-based patient records

1970s - Giant Leap for NI

Nurses began to recognize the value of the computer for their profession. Giant steps
were taken in both nursing and computer technology. Nurses assisted in the design
of Health Information system (HISs) and other environment that lead to the
development of forerunning software as bases of today’s systems. Computer
applications for financial and management functions of patient care systems were
perceived as cost-saving technologies. Several States and large community health
agencies in the US developed and/or contracted for their own computer-based
Management Information Systems (MISs) which provided statistical and financial
information required by local government and federal agencies for specific program
funds and reimbursement of patient services such as Medicare, Medicaid and other
third-party payers.

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1980s - Emergence of Informatics Field
The field of Informatics emerged in the healthcare industry and nursing. NI became
an accepted specialty and many nursing experts entered the field. Technology
challenged creative professionals and the use of computers in nursing became
revolutionary. The need for nursing software evolved and nursing education
identified the need to update practice standards, determine data standards,
vocabularies and classification schemes that could be coded for Computer-based
Patient Record Systems (CPRSs). Many mainframe HISs emerged with nursing
subsystems that documented several aspects of the patient record including Kardex,
results reporting, vital signs and other system that documented narrative nursing
notes via word-processing packages. Discharge planning systems were also
developed and used as referrals to community healthcare facilities in the continuum
of care. The microcomputer, widely known as the personal computer (PCs) emerged
that made computers more accessible, affordable and usable by nurses. It served not
only terminals linked to mainframe PCs but also as stand-alone systems or
workstations.

1990s - Affirmation of Nursing Informatics as Specialty Field

Computer technology became an integral part of healthcare settings, nursing practice
and nursing profession. Professional organizations identified initiatives that
addressed IT and informatics. Policies and legislation were adopted promoting
computer technology in healthcare including nursing. The nursing profession
became actively involved in promoting NI. NI was approved by American Nurses
Association (ANA) as a new nursing specialty. The need for computer-based
nursing practice standards, data standards, nursing minimum data sets and
national databases emerged concurrent with the need for a unified nursing
language including nomenclatures, vocabularies, taxonomies and classification
schemes. Nurse administrators demanded that HISs should include nursing
protocols and, nurse educators continued to require use of innovative technologies
for all levels and types of nursing and patient education. Nurse researchers required
knowledge presentation, decision support, and expert systems based on aggregated
data. The 1990s brought about development of smaller and faster computers –
laptops and notebooks, workstations, Local Area Network (LANs) and Wide Area

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Networks (WANs). The internet made it possible for the information and
knowledge databases to be integrated into bedside systems.

Post 2000 - Rapid Growth and Development in NI

Healthcare and nursing undergone developments such as wireless point of care,
open source solutions, regional database projects and increased IT solutions on
healthcare environment. Clinical information systems became individualized in the
Electronic Patient Record (EPR) and patient specific systems considered for the
lifelong longitudinal record or the Electronic Health Record (EHR). Mobile
computing devices were also introduced such as Personal Digital Assistants (PDAs),
Tablet computers and smart phones. The Voice over Internet Protocol (VoIP)
promises to provide cheap voice communication for healthcare organizations. The
prediction of smart cards was realized in Europe (Germany). The internet has
provided a means for development of clinical applications. Critical care units are
monitored remotely by health providers. Telenursing, a recognized specialty since
the late 1990s, is increasing in popularity and providing patient care in an efficient
and expeditious fashion

Four Major Areas of NI Application

The historical perspectives on nursing that shaped the need for computers,
information technologies and informatics can be describe through focusing on four
major areas in nursing

Nursing Practice
Nursing practice has evolved and changed radically. It has become an integral part
of the Electronic Health Record (EHR). Computer systems with nursing, and patient
care data, nursing care plans are no longer separate subsystems of the computerized
HISs, but rather integrated into one interdisciplinary patient health record in the
Electronic Health Record (EHR). The need for an interdisciplinary EHR resulted
because of the many initiatives proposed and promoted by the nursing profession as
well as by the other health care providers. They all require patient care data to track
the care process. Further, nursing practice data emerged with the introduction of
several nursing terminologies that were recognized by the ANA as coded
terminologies usable for the EHR. They are used to assess problems, document care,

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track the care process and measure outcomes. Thus, the electronic version of nursing
practice – the computer – has revolutionized and transformed nursing practice.

Nursing Administration
Nursing administration in hospitals has also changed with the introduction of the
computer that links nursing departments together. Most hospital policies and
procedure manuals are accessed and retrieved by computers. Furthermore, work load
measures, acuity systems and other nursing department systems are online and
integrated with the hospital or patient’s EHR system or in separate nursing
department systems. The internet is being used by nurses to access digital libraries,
online resources, and research protocols at the bedside.

Nursing Education
The computer has radically changed nursing education. Most universities and
schools of nursing offer computer-enhanced courses, online courses and/or distance
education. Campus wide computer systems are available for students to
communicate via e-mail, transfer data files, access digital libraries, and retrieve
online resources from millions of Internet sites. An email accounts is considered a
gateway to these possibilities. New educational strategies require different methods
of teaching. The advent of computers in educational technology has greatly
revolutionized teaching methodologies and strategies. Today, most faculty members
use the Internet to teach courses via the Web and communicate with other students
via email. The students on the other hand have to be more active and assume more
responsibility for their education that can be enhanced through the use of the Web.
Nursing Research
Nursing research provides the impetus to use the computer for analyzing computer
data. Software programs are available for processing both quantitative and
qualitative research data. With the advancement of computer technology databases
supporting nursing research emerged, principally for online searching and retrieving
information from the electronic bibliographic information systems or other
databases that contain relevant healthcare content, such as drug data. The internet
also provides online access to millions of Web resources around the world which
have increased the capabilities and expanded the field of nursing research

Why nursing informatics and not Medical informatics?

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  Nursing informatics provides ―a nursing perspective
 illuminates nursing values and beliefs
 denotes a practice base for nurses in health informatics
 produces unique knowledge specifically for nurses
 distinguishes groups of practitioners,
 focuses on the phenomena of interest for nursing
 provides needed nursing language and word context
Importance of Nursing Informatics
NI is important as it;
 Helps to track patient health data, records clinical outcomes
 Monitors the quality of healthcare delivery and evaluates provider
performance.
 Enhances decision-making in all direct and indirect nursing roles through the
collection, extraction, aggregation, analysis and interpretation of standardized
data using the emerging principles and methods of data science
 Add value to our health-care system while decreasing costs
 Enhance the shift toward person-centered approaches to care delivery
 Nursing informatics facilitates nursing engagement with digitally connected
health services environments. The concept of digitally connected healthcare
include the use of ICTs to empower nurses and is inherently patient-centered.
It emphasizes the use of ICTs to help individuals and their families’ track,
manage and improve their health.
 Enhance fast/prompt access to patient information while reducing patient
waiting time
 Improve efficiency and reduce the potential for errors in documentation
 Facilitate and enhance nurses use of standardized nursing language.
Standardized Nursing Languages are standardized clinical terminologies best
suited for documenting, communicating, aggregating and analyzing the
nursing contribution to patient care. The adoption and use of these
terminologies has allowed nursing data across the continuum to be linked and
compared with data from other health-care professions
 Enhance gathering and utilization of data from multiple sources to make
decisions and support patients’ decision-making

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  Help in advancing nurse researchers’ understanding of the emerging field of
data science as it pertains to knowledge development and advancements in
practice, education and policy.
 It is associated with increased quality, safety and efficiency in patient care
delivery
Impact of Nursing Informatics on Patient care
 Streamlines documentation and communication: Nursing informatics
which functions through integrated databases provides quick and easy access
to a wide range of patient information, including medical history, treatment
plans, laboratory and imaging results as well as healthcare team notes. Some
NI components used to improve the documentation and communication
process include Electronic Health Records (EHR) and Computer Provider
Order Entry (CPOE).
 Enhanced informed decision making: NI enhance nurses’ ability to make
informed decisions that are more accurate and at faster rate thus delivering a
higher level of patient-centered care.
 Low Healthcare Costs: The rising cost of healthcare is a serious challenge
globally. One of the primary ways healthcare organizations are attempting to
reduce healthcare cost is through improved efficiencies through the use of
computer and information science. With the use of integrated healthcare
technology systems, many tedious administrative tasks are automated,
improving productivity and lowering costs related to human resource
recruitment and retention. Also, with streamlined processes, teams work more
efficiently with less stress on the staff.
 Enhance accessibility and client information sharing: Because of
electronic charting, nurses are able to obtain information quickly and
efficiently and use the information to improve the daily workflow. Storing the
information electronically is more easily available to all members of the care
team, including the physician and other care providers, as well as staff teams
at other healthcare organizations that the patient may visit.
 Help in coordination of nurses’ work and staff ratio: The ability to track
staffing, workflow and communication can help nurses to identify areas where
current processes can be improved. This can also help ensure that staffing
levels remain adequate which is critical for providing patients with the best

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 possible care. If the nurse-to-patient ratio drops too low, patients are more
likely to suffer adverse results.
 Promote Evidenced- based practices: Determining best practices involves
the use of health informatics. The more data that is collected and analyzed,
the more accurate the resulting conclusions tend to be thus providing the best
possible information for determining how best to care for patients in the
future.
 Improve Clinical Policies, Protocols, Processes and Procedures: Data is
the lifeblood of nursing informatics. Data and information can be used to
measure the success of the various protocols, processes, and procedures used
in a healthcare organization. A nurse informaticist will measure and analyze
how specific parts of the organization are performing with a focus on the
resulting patient outcomes.
 Minimize medical and care errors: Patient safety is a primary concern of
any health care provider and nurses are often on the front lines of ensuring
that their patients are kept safe and preventing medication errors,
misdiagnoses, falls, and other problems is a priority. Health informatics
provides important data that can prevent these errors.
Also, clear communication among healthcare team members based on prompt
and consistent documentation speeds patient care and reduces the chances of
costly medical errors.
 Improved Coordination of Care: Nurses are often called upon to help
coordinate the care of their patients. This often means relaying information
from physicians, therapists, pharmacy, billing and more, both during care and
at discharge. Without all of the necessary information, patient care could
suffer. Informatics improves the coordination of this information, allowing
nurses to give their patients all of the information they need, improving both
outcomes and the satisfaction with care.

Components of Nursing Informatics practice

The transformation of data to knowledge is a key concept of the nursing informatics
practice and has the potential to significantly impact nursing practice. It has three
components viz:
1. Data: Data are discrete entities that are described objectively without
interpretation

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2. Information: Information is data that are interpreted, organized, or structured
3. Knowledge: Knowledge is information that is synthesized so that relationships are
identified, formalized and applied.
As data are transformed into information and information into knowledge,
each level increases in complexity and requires greater application of human
intellect. As an example, a single instance of vital signs – heart rate, respirations,
temperature and blood pressure – for a single patient can be considered a set of data.
A series of vital signs taken over time, placed into a context, and compared is
considered information. However, a dropping blood pressure, increasing heart rate,
respiratory rate, and fever in an elderly, catheterized patient are recognized as being
out of the norm. The recognition that this patient may be septic and in need of nursing
and medical interventions reflects information synthesis (knowledge)

Required competencies
Informatics is a combination of nursing science, information science and computer
science. The basic nursing informatics competencies required include:
 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.
 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

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 of basic science research to support the theoretical development of
informatics.

Basic Principles of Nursing Informatics

ANA standards of nursing informatics practice outlined the following as the
principles of Nursing Informatics.
 Distinct specialty practice and body of knowledge
 Includes both clinical and non-clinical
 Supports nurses to improve quality of care and welfare of health care
consumers
 Focus on delivering right information to right person at the right time
 Human factors concepts are interwoven in practice
 Ensure confidentiality and security of data and information and advocates
privacy
 Promotes innovative, emerging and established information technology
 Collaborates with and is closely linked to other health-related informatics
specialties

Responsibilities within Nursing Informatics

Nurse informatics have different roles and responsibilities in healthcare, each
bringing value to the provision of patient care. Identified responsibilities of nursing
informatics (HIMSS, 2012) include:
 Analyze both clinical and financial data
 Facilitate resource and reference access
 Protected materials using copyright policies
 Deliver nursing content in
 standardized languages
 Improve continuity of care
 Enhance relationships between providers and patients
 Support cost savings and goals for productivity
 Sustain nursing work processes using technology
 Redesign clinical workflow
 Assist with change management
 Encourage provision of high quality, evidence-based care
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  Facilitate true interdisciplinary care

The roles of a Nurse Informatics specialist (Nurse Informaticist)

A nurse Informatics specialist is one who has a bachelor in nursing science with an
additional master’s degree or additional education in nursing informatics.
 A nurse informatics specialist (or “informatics nurse”) merges the art of caring
for people and computer science
 Work to develop communication and information technologies in health care.
 They serve as educators, researchers, software engineers, and chief nursing
officers. Using the "building blocks" listed above,
 A nurse informatics help develop evidence-based policies and procedures for
organizations.
 Nurse informaticists support nurses, consumers, patients, the inter-
professional healthcare team and other stakeholders in their decision-making
in all roles and settings to achieve desired outcomes. This support is
accomplished through the use of information structures, processes, and
technology.

Qualities of an Informatics Nurse

There are some qualities in particular that facilitate work as an informatics nurse.
There include:
 Technologically Proficient.
 Good communication skills
 Organized
 Strong analytical skills
 Strong critical thinking skills
 Problem-solving
 Project management skills.

Challenges of nursing informatics application

 Poor integration into practice

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  Poor interoperability (ability of computer systems or software to exchange
and make use of information) in actual practice
 Problems with the organization’s strategic plan, software design,
infrastructure and time management.
 Regular system failures
 Legal Issues in Nursing Informatics
 Lack of planning for training and retraining of nurses
 Resistant to change among some nurses

Use of computers in daily nursing work

- Practice: knowledge of nursing information systems can be used with nursing
practice such as patient documentation, monitoring devices, developing and
implementing care plans and pathways, retrieval of previous records and
imaging, use of tele-health, and access to current practice standards.
- Administration: Information systems are used in communication, staff
scheduling systems, cost and budget analysis, and monitoring of trends with
quality and satisfaction data.
- Education: Informatics and technology has applications in education,
including simulation, electronic learning, teleconferencing, and software
availability for educational presentations and programs.
- Research: Internet capabilities and electronic databases provide rich access
to obtaining, compiling and conducting research
- Documentation: Used in documentation of client personal health-care story,
the treatments they carry out, client responses and progress toward health care
goal for monitoring and for ready access by other team members.
- Retrieving information: about the past and ongoing treatments; medications
and the results to ensure the best care is provided.
- Review data about client current and past health situation and plan of care on
the electronic health record, which helps them monitor client recovery process
over time.

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 - Access clinical knowledge such as drug information, nursing assessments,
articles and nursing best practice guidelines and resources to better understand
client health situation and plan of care.
- Monitor patient health status

What types of computers and information technology do nurses use

- Nurses use computers similar to those that are use at home or at work. They
use software programs specifically designed to support the work of nurses and
other health-care team members.
- Nurses may also use a small hand held computer known as Personal Digital
Assistants or PDAs. PDAs are very similar to the Blackberry or iPhone that
people or families and friends may use at home or work.

References
Camilli, S. (2014). Plugging into nursing informatics: Preparation, practice, and
beyond. Canadian Journal of Nursing Informatics, 9(1-2).
http://cjni.net/journal/?p=3508
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825491/
Hindawi (2016) How Nurses Are Using Health Informatics to Improve Patient Care.
https://electronichealthreporter.com/s
International Medical Informatics Association. (2009). IMIA-NI definition of
nursing informatics updated. Retrieved from
https://imianews.wordpress.com/2009/08/24/imia-ni-definition-of nursing-
informatics-updated/
McGonigle, D., & Mastrian, K (2015). Nursing informatics and the foundation of
knowledge. Burlington, MA : Jones & Bartlett Learning.
McHugh, M.L (2021) Computer Systems Basics—Hardware. Nurse Key.
https://nursekey.com/computer-systems-basics-hardware/
Simpson, R. L. (2013). Chief nurse executives need contemporary informatics
competencies.

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Nursing Economics, 31, 277-288.
http://www.nursingeconomics.net/ce/2015/article3106277287.pdf

The Canadian Nurses Association (CNA) (2017) Joint Position statement: Nursing
Informatics. https://cnia.ca/resources/Documents/Nursing-informatics-joint-
position-statement.

Tietze, M (n.d) Nursing Informatics: What’s It All About?

University of Illinois Chicago (2020) The impact of health informatics on nursing

practice. https://healthinformatics.uic.edu/

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