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Essentials of
Nursing
Informatics
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CONTENTS
Author deceased
†
Gregory L. Alexander, PhD, RN, FACMI, FAAN Cristina Robles Bahm, PhD, MSIS
Helen Young CUPHSONAA Professor Assistant Professor
Columbia University Program Coordinator
School of Nursing Chair Computer Science
New York, New York La Roche University
Chapter 9: Human–Computer Interaction Pittsburgh, Pennsylvania
Chapter 6: Data and Data Processing
Patricia E. Allen, EdD, RN, CNE, ANEF, FAAN
Professor Emeritus, Texas Tech University–Health Melissa Barthold,† DNP, MSN, RN-BC, CPHIMSS,
Science Center FHIMSS
School of Nursing Principal
Lubbock, Texas Nursing Informatics Consulting
Chapter 46: Initiation and Management of Cape Coral, Florida
Accessible, Effective Online Learning Chapter 24: Mastering Skills that Support Nursing
Dixie B. Baker, PhD, MS, MS, BS, FHIMSS Amy J. Barton, PhD, RN, FAAN, ANEF
Senior Partner, Martin, Blanck and Associates Professor Daniel & Janet Mordecai Rural Health
Alexandria, Virginia Nursing Endowed Chair
Chapter 10: Trustworthy Systems for Safe College of Nursing
and Private Healthcare University of Colorado Anschutz Medical Campus
Aurora, Colorado
Suzanne Bakken, PhD, RN, FACMI, FIAHSI, Chapter 21: Informatics Applications to Support
FAAN Rural and Remote Health
The Alumni Professor of Nursing and Professor
of Biomedical Informatics Margaret S. Beaubien, MS, MSN, RN, CPHIMS
Columbia University Captain, NC, USN (Retired)
New York, New York Napa, California
Chapter 17: Foundations of Nursing Informatics Chapter 30: Federal Healthcare Sector Nursing
Informatics
Khadija Bakrim, EdD
Educational Technologist Carol J. Bickford, PhD, RN-BC, CPHIMS, FAMIA,
Texas Tech University Health Science Center FHIMSS, FAAN
School of Nursing Senior Policy Advisor
Lubbock, Texas American Nurses Association
Chapter 46: Initiation and Management of Accessible, Silver Spring, Maryland
Effective Online Learning Section Editor—Part 1: Nursing Informatics Technologies
Chapter 16: The Practice Specialty of Nursing Informatics
Author deceased
†
ix
Veronica D. Feeg, PhD, RN, FAAN Evelyn J. S. Hovenga, PhD, RN, FACHI, FACS,
Professor, Associate Dean FACN, FIAHSI
Barbara H. Hagan School of Nursing CEO, Professor & Director, eHealth Education PTY Ltd
Molloy College Director, Global eHealth Collaborative (GEHCO)
Rockville Centre, New York East Melbourne, Victoria
Section Editor—Part 9: Research Applications Australia
Chapter 49: Computer Use in Nursing Research Chapter 20: Using Six Sigma and Lean for Measuring
Quality
Rebecca Freeman, PhD, RN, FAAN, FNAP
University of Vermont Susan C. Hull, MSN, RN-BC, NEA, FAMIA
Vice President of Health Informatics Chief Health Information Officer
Burlington, Vermont CareLoop, Inc.
Chapter 18: Establishing Nursing Informatics Boulder, Colorado
in Public Policy Co-chair, Alliance for Nursing Informatics
Chapter 17: Foundations of Nursing Informatics
Nicholas R. Hardiker, PhD, RN, FACMI Chapter 36: New Models of Healthcare Delivery and
Professor of Nursing and Health Informatics and Retailers Producing Big Data
Associate Dean (Research & Enterprise)
School of Human and Health Sciences Elizabeth (Liz) Johnson, MS, FAAN, LCHIME,
University of Huddersfield FCHIME, CHCIO, FHIMSS, RN
Huddersfield, United Kingdom Retired Chief Innovation Officer
Chapter 8: Standardized Nursing Terminologies Tenet Health
Dallas, Texas
Lynda R. Hardy, PhD, RN, FAAN Chapter 22: Communication Skills in Health IT, Building
Director, Data Science & Discovery Strong Teams for Successful Health IT Outcomes
Associate Professor, Clinical
R. Renee Johnson-Smith, RN, MBA
The Ohio State University
Roudebush VA Medical Center
College of Nursing
Risk Manager
Columbus, Ohio
Indianapolis, Indiana
Chapter 26: Improving Healthcare Quality and Patient
Chapter 31: Monitoring Interoperability, Device
Outcomes Through the Integration of Evidence-Based
Interface, and Security
Practice and Informatics
Irene Joos, PhD, RN, MSIS
Lois M. Hazelton, RN, Dip App Sci (Nurs), B App Professor, IST
Sci (Ad Nurs), PhD (Entrepreneurship), FACN Adjunct Professor, Nursing
Independent Consultant and Researcher La Roche University
Nerrina, Victoria Pittsburgh, Pennsylvania
Australia Chapter 6: Data and Data Processing
Chapter 20: Using Six Sigma and Lean for Measuring
Quality
Mary Ann Lavin, DSc, RN, ANP-BC (Retired), Michael E. Ludwig, MSN, RN-BC, CPHIMS
FNI, FAAN U.S. Army
Multidimensional Search and Design Consultant Chapter 30: Federal Healthcare Sector Nursing
Founder and President, TIIKO, LLC Informatics
Associate Professor Emerita
Saint Louis University E. LaVerne Manos, DNP, RN-BC, FAMIA
Trudy Busch Valentine School of Nursing Program Director
Saint Louis, Missouri Interprofessional Master of Science in Health
Chapter 28: Structuring Advanced Practice Knowledge: Informatics & Post-Master’s Certificate in Health
Curricular, Practice, and Internet Resource Use Informatics
Director, Informatics
Chanmi Lee, BSN, RN, FNP-C Director, Center for Health Informatics
Family Nurse Practitioner Clinical Associate Professor
Stride Community Health Center Kansas University Center for Health Informatics
Aurora, Colorado Kansas University School of Nursing
Chapter 47: Social Media Tools in the Connected Age Kansas City, Kansas
Chapter 48: A Paradigm Shift in Simulation:
June Levy, MLS Experiential Learning in Virtual Worlds and Future Use
Vice President of Virtual Reality, Robotics, and Drones
CINAHL Information Systems
Glendale, California Karen M. Marhefka, DHA, MHA, RHIA
Chapter 50: Information Literacy and Computerized Principal, Impacts Advisors
Information Resources Naperville, Illinois
Chapter 22: Communication Skills in Health IT,
Yu-Chuan (Jack) Li, MD, PhD, FACMI, FACHI, Building Strong Teams for Successful Health IT Outcomes
FIAHSI
Distinguished Professor and Dean, Graduate Heimar F. Marin, RN, MS, PhD, FACMI
Institute of Biomedical Informatics Alumni Professor, Nursing and Health
College of Medical Science and Technology Informatics
Taipei Medical University Federal University of São Paulo
Taipei, Taiwan Fellow, American College of Medical
Chapter 35: Consumer Patient Engagement and Informatics
Connectivity in Patients with Chronic Disease in the Editor-in-Chief, International Journal of
Community and at Home Medical Informatics
São Paulo, São Paulo
Pia Liljamo, PhD, RN Brazil
Development Manager Chapter 43: Global eHealth and Informatics
Oulu University Hospital Administrative Centre
Oulu, Finland Sarah Mattice, MS, RN
Chapter 42: Nursing Informatics Innovations Adjunct Instructor
to Improve Quality Patient Care on Many University of Colorado
Continents College of Nursing
Aurora, Colorado
Chapter 47: Social Media Tools in the Connected Age
Lynn M. Nagle, PhD, RN, FAAN Susan K. Newbold, PhD, RN-BC, FHIMSS, FAMIA,
Director, Digital Health and Virtual Learning FAAN
Adjunct Professor Owner
Faculty of Nursing Nursing Informatics Boot Camp
University of New Brunswick Franklin, Tennessee
Adjunct Professor Chapter 12: System Design Life Cycle: A Framework
University of Toronto
Western University Chris E. Nichols, MHA, RN
Editor-in-Chief, Canadian Journal of Nursing Leadership LSSBB Program Manager
President Enterprise Intelligence & Data Solutions PMO
Nagle & Associates Inc. Defense Healthcare Management Systems PEO
Health Informatics Consulting Falls Church, Virginia
New Brunswick/Toronto, Canada Chapter 30: Federal Healthcare Sector
Chapter 41: Nursing Data Science and Quality Nursing Informatics
Clinical Outcomes Hyeoun-Ae Park, PhD, RN, FACMI, FAAN, FIAHSI
Eun-Shim Nahm, PhD, RN, FAAN Professor
Professor Seoul National University
Organizational Systems and Adult Health School of Nursing and Medical Informatics
University of Maryland Interdisciplinary Program
School of Nursing Seoul, Republic of Korea
Baltimore, Maryland Chapter 35: Consumer Patient Engagement and
Chapter 44: Nursing Curriculum Reform and Connectivity in Patients with Chronic Disease in the
Healthcare Information Technology Community and at Home
Chapter 43: Global eHealth and Informatics
Naoki Nakashima, MD, PhD
Professor/Director, Medical Information Center Ellen Pollack, MSN, RN-BC
Kyushu University Hospital, Japan Chief Nursing Informatics Officer
Fukuoka City, Japan UCLA Health
Chapter 35: Consumer Patient Engagement and Los Angeles, California
Connectivity in Patient with Chronic Disease in the Chapter 29: Beyond EMR Implementation: Optimize
Community and at Home and Enhance
Lynn A. (Slepski) Nash, PhD, RN, PHCNS-BC, FAAN Susy Postal, DNP, RN-BC
Captain (Retired), U.S. Public Health Service Chief Health Informatics Officer
Gaithersburg, Maryland Indian Health Service
Chapter 33: Informatics Solutions for Emergency Rockville, Maryland
Planning and Response Chapter 30: Federal Healthcare Sector Nursing
Informatics
Ramona Nelson, PhD, RN, BC, FAAN
Professor Emerita Diane S. Pravikoff, RN, PhD, FAAN
Slippery Rock University Vice President, Research (Retired)
President CINAHL Information Systems
Ramona Nelson Consulting Glendale, California
Pittsburgh, Pennsylvania Chapter 50: Information Literacy and Computerized
Chapter 6: Data and Data Processing Information Resources
Paula M. Procter, RN, CertED (FE), MSc, SFHEA, Virginia K. Saba, EdD, RN, FACMI, FAAN, LL
FBCS, CITP, FIMIANI, IAHSI CEO & President
Professor of Nursing Informatics Sabacare.com
Department of Nursing and Midwifery Arlington, Virginia
Sheffield Hallam University Distinguished Scholar, Adjunct
Sheffield, United Kingdom Georgetown University
Chapter 11: Social Determinants of Health, Electronic Washington, District of Columbia
Health Records, and Health Outcomes Professor, Adjunct
Uniformed Services University
Stephanie J. Raps, MSN, RN-BC Bethesda, Maryland
Doctoral Candidate Book Editor and Section Editor—Part 1: Nursing
Daniel K. Inouye Graduate School of Nursing Informatics Technologies
Uniformed Services University of the Health Sciences Part 4: Informatics Theory Standards
Major, U.S. Air Force Chapter 1: Historical Perspectives of Nursing
Bethesda, Maryland Informatics
Chapter 30: Federal Healthcare Sector Nursing Appendix: Clinical Care Classification (CCC) System:
Informatics Overview, Applications, and Analyses
Theresa (Tess) Settergren, MHA, MA, RN-BC Mark D. Sugrue, RN-BC, MSN, FHIMSS
Director, Nursing Informatics (Retired) Managing Director, Clinical Delivery & Informatics
University of Minnesota Solutions
Minneapolis, Minnesota Commonwealth Medicine
Chapter 13: System and Functional Testing University of Massachusetts Medical School
Member, HIMSS North America Board of Directors
Roy L. Simpson, DNP, RN, DPNAP, FAAN, FACMI (2019–2020)
Assistant Dean, Technology Management and Chair, HIMSS North America Board of Directors
Clinical Professor (6/2020–2021)
Doctoral Program: Doctorate Nursing Shrewsbury, Massachusetts
Practice Chapter 38: Telehealth: Healthcare Evolution in the
Nell Hodgson Woodruff School of Nursing Technology Age
Emory University
Atlanta, Georgia Gerald N. Taylor, MD, MPH
Chapter 40: Big Data Analysis of Electronic Health Flight Surgeon, Diplomate American Board of
Record (EHR) Data Preventive Medicine
Captain, USPHS
Diane J. Skiba, PhD, FACMI
Coast Guard Chief Medical Informatics Officer
Professor Emeritus
Washington, District of Columbia
University of Colorado
Chapter 30: Federal Healthcare Sector
Aurora, Colorado
Nursing Informatics
Media Editor
Chapter 47: Social Media Tools in the Connected Age
Denise D. Tyler, DNP, MSN/MBA, RN-BC
Carolyn Sipes, PhD, CNS, APRN, PMP, RN-BC, Clinical Specialist
NEA-BC, FAAN Visalia, California
Professor, Core Faculty, PhD Program Section Editor—Part 3: System Life Cycle
Walden University Chapter 13: System and Functional Testing
Minneapolis, Minnesota Chapter 14: System Life Cycle Tools
Chapter 16: The Practice Specialty of Nursing
Informatics Barbara Van de Castle, DNP, APRN-CNS, OCN,
RN-BC
Kathleen Smith, MScEd, RN-BC, FHIMSS
Assistant Professor
Managing Partner
University of Maryland School of Nursing
Informatics Consulting and Continuing
Baltimore, Maryland
Education, LLC
Nurse Educator
Weeki Wachee, Florida
Sidney Kimmel Comprehensive Cancer Center
Section Editor—Part 5: Policies and Quality
Johns Hopkins University
Measurement in Health Care
Baltimore, Maryland
Chapter 23: Nurse Scheduling and Credentialing
Chapter 15: Healthcare Project Management
Systems
In the years since the previous edition of Essentials in ultimately, build wisdom—into nursing practice, nursing
Nursing Informatics was published, U.S. hospitals have informatics is uniquely positioned to help lead the opti-
achieved nearly universal adoption of electronic health mization journey that will simplify data capture, promote
record (EHR) systems. Physician offices are only slightly sharing of data in a mobile environment, and create high-
behind in joining the digital ranks, and health profession- performing, patient-centric clinical information systems.
als across the nation now utilize EHR systems in daily The vision for a better future of healthcare is tightly
practice. The “HITECH Act” has forever changed health associated with the future of health information technol-
informatics, and we now face new challenges in improv- ogy, and data are the fuel for this journey. Thus, nurse
ing usability, interoperability, and learning capability of informaticists are critical healthcare leaders for the 21st
these systems. With the rise of artificial intelligence and century, experts in the right place at the right time, bring-
a need to reduce documentation burden required by cur- ing the clinical, technical, and leadership skills together to
rent EHR systems, we see significant opportunity and create effective partnerships among their numerous con-
responsibility for healthcare providers to address these stituencies—leadership teams, clinicians, data scientists,
challenges. Nurse informaticists are at the center of this information technologists, and more. Their role is central
transformational opportunity. in advancing value and science-driven healthcare, and so
Historically, care teams communicated primarily their work in moving healthcare informatics from data
through written notes in the patient chart. Paper repre- management to decision support is essential.
sented a technical barrier, as the best patient care is depen- In the 15 years since the call for EHRs was made in
dent on data availability over time, across locations, and the 2004 Presidential State of the Union message, we have
among healthcare team members—including the patient. witnessed rapid evolution of health information technol-
Access to the most accurate and complete information ogy and its use in healthcare systems. The next 15 years
remains vital, and nursing informaticists are leading much will bring the increasing convergence of data from myr-
of the work being done to improve the speed, accuracy, iad sources outside of the formal healthcare setting into
and utility of clinical information. the context of clinical care. We will move up the analytic
We have made progress in gaining nearly instant access hierarchy from descriptive to diagnostic, predictive, and
to patient data and evidence-based decision support that ultimately prescriptive and autonomous systems. Thus,
enables nurses, physicians, and other clinicians to make the future of this field promises both challenge and oppor-
better decisions about patient care. These technologies, tunity for prepared participants.
however, require continued optimization of the tech- Just as the field has evolved, so has nursing informat-
nology, the interoperability, and the workflow to drive ics. Its practitioners have already provided tremendous
improvement in user experience, reduce documentation energy, insight, and leadership in helping to establish the
burden, and improve patient outcomes. necessary infrastructure and in driving gains in healthcare
The accelerating demands for gathering and using technology competency, information literacy, and better
data to improve patient care and clinical operations have healthcare outcomes. Now more than ever, we believe
increased awareness of informatics as a core skill, inten- nursing informatics holds great promise to enhance the
sifying the need for clinicians to better understand these quality, continuity, value, and experience of healthcare.
increasingly ubiquitous technologies. This edition incor-
Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI
porates updated teaching aids to help educators develop
President, Clinical Services Group and Chief Medical
more sophisticated users of technology, who are equipped
Officer
to improve processes and workflows that result in safer,
HCA Healthcare
more effective, and efficient patient care.
As the specialty that integrates nursing science, com- Jane D. Englebright, PhD, RN, CENP, FAAN
puter science, and information science to manage and Senior Vice President and Chief Nurse Executive
communicate data, information, and knowledge—and HCA Healthcare
xix
Simone säpsähti:
— Te?
— Te rakastitte häntä?
— Mutta entä tuo mies… mitä hän teki, mitä hän puhui?
— Hän? toisti hän. — Mitä hän sitten olisi voinut sanoa minulle?
Tuo kaikkihan tapahtui vain minun omassa järjettömässä
mielessäni… Eihän hän tiennyt mitään koko asiasta!
»Minä kerron tuon asian herra Petitbois'ille, hän voi antaa minulle
hyvän neuvon.»
— Jos ei hän olekaan nuori mies, neiti Lise? Jos hän onkin
päinvastoin kiltti vanha ukkeli? Luonnon lapsipuoli, joka olisi hänkin
halunnut olla kaunis, voittaa rakkautta! — raajarikko, joka on
haaveillut avarasta maailmasta, matkoista… elämän onnea vaille
jäänyt olento, vanhus, jolla ei ole ollutkaan nuoruutta…
— Kuten teillä…
(Aihe viuhkamaalauksista.)
Kumpiko heistä sitten oli oikeassa? Sitä olisi minun varsin vaikea
sanoa, niin sekaisin olivat oikeudenjakajat panneet kaikki asiat. Joko
markiisitar — tai kenties herttua. Jollei toinen, niin toinen, — siihen
viittasivat asiakirjat. Eräs syvämietteinen ihmisvihaaja, La
Rochefoucauld, joka varmaankin oli selvillä tämäntapaisista asioista,
on sanonut että riidat saataisiin aina nopeasti ratkaistuiksi, jos
vääryyttä olisi tapahtunut ainoastaan toiselta puolelta. Kuinka lienee
ollutkaan, — joka tapauksessa oli herttuan ja markiisittaren
oikeudenkäyntiä kestänyt jo melkein seitsemän vuotta.
*****
*****
— Hyvä täti, enhän ole vielä jutellut hänelle niin pitkälti kuin hän
kirjoittaa teille, vastasi Doris hymyillen. — Herttuan täytyy olla teihin
kiihkeästi ihastunut, voidakseen sanoa teille niin viehkeällä tavalla
niin paljon miellyttäviä seikkoja, ja luulen… niin kyllä, minä luulen,
että hän tekee teidät onnelliseksi. Hän on herttainen mieleltään ja
lämminsydäminen!
*****
Mutta päivä lähestyi, jolloin kirkon siunauksen piti yhdistää
Troncantiquen ja Souchevieillen suvut.
*****