Nursing Informatics. Asieh Dervish Faculty of Nursing & Midwifery Tehran University of Medical Sciences sedarvish@yahoo.com adarvish@farabi.tums.ac.

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1 Asieh Dervish Faculty of Nursing & Midwifery Tehran University of Medical Sciences Objectives Introduce Managing medical knowledge Nurse & Technology Interaction Conclusion ٢ ١

2 Late 1960 s first computer systems were implemented in hospitals Nurses felt the need of new technologies in hospitals Technically curious and willing to try new things ٣ NI as a specialty Guenther & Peterz (2006) NI is seen as specialty in literatures in 1984 Roles, titles and responsibilities varied Definitions similar, conceptual models considered, research in varied directions Panel assembled to help sort out the pieces ۴ ٢

3 1989- Graves and Corcoran defined as Computer science, information science, and nursing science combined 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. ۵ Turley defined Nursing Informatics as the intersection point with Nursing Science, Computer Science and Information Science. ۶ ٣

4 American Nurses Association Recognized as a specialty in 1992 Defined NI, outlined roles and responsibilities and developed standards for practice. Certification for generalist ٧ 1994, Scope of Practice for Nursing Informatics is the 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, research, and the expansion of nursing knowledge. ٨ ۴

5 2001, Scope and Standards of Nursing Informatics Practice NI is an evolving field - expect change in definitions Three categories of definitions Technology focused Conceptually focused Role-Orientated ٩ Certification The first computer technology lesson to nursing students in 1976 During last 25 years, increased lesson numbers & graduations levels Began in 1995 Knowledge expected of a NI generalist ١٠ ۵

6 Focus Areas System Analysis and Design System Implementation and Support System Testing and Evaluation Human Factors Computer Technology Information/Database Management Professional Practice/Trends and Issues ١١ The exercise of specialist knowledge and competencies Emphasis on the knowledge which is located in brains, dialogue and symbols ١٢ ۶

7 Nursing is a Cognitive Discipline Nursing Actions To, With, and For the Client are the Visible Manifestations of Nurses Thinking Knowledge Work Requires Data, Information and Knowledge ١٣ Data - from the client; collected, recorded, d managed by RNs Information - data analysis and interpretation in context by RNs Knowledge - clinical information is used to expand nursing and other health care sciences through research and other scholarly work ١۴ ٧

8 Education NI Specialist Preparation Registered Nurses already in practice Continuous entry of students ١۵ Scope of Practice (ANA) Standards of Practice (ANA) Board Certification (ANCC) Preparation Graduate Preparation (Masters) PhD Programs Certificate Programs ١۶ ٨

9 Competencies for NI practitioners Data, Information, Knowledge Atomic Level Data Knowledge Seeking Critical Analysis of D, I, K Information Technologies Electronic Health Records & Systems Internet ١٧ Competencies for NI practitioners Computer Skills Informatics Knowledge Informatics Skills ١٨ ٩

10 Computer Skills ١٩ Informatics Knowledge ٢٠ ١٠

11 Informatics Skills ٢١ Knowledge Representation Nursing Concepts Decision Analysis & Evaluation Scarcity and Conflict Collaboration and Team Work Data Aggregation and Analysis Economics, History, Political Science ٢٢ ١١

12 Collection & preservation of nursing data is critical Explanation of variances in client outcomes Accurate cost of care: individual, groups of clients, community, covered lives... Knowing what works, what doesn t & why ٢٣ NI Education Issues Integration into curricula vs. separate courses Inclusion of multi-disciplinary healthcare informatics - how, when, where, what Informatics competencies for all registered nurses Competencies for NI practitioners ٢۴ ١٢

13 Managing medical knowledge Data Information knowledge Wisdom Skill Specialty Expert ٢۵ Managing medical knowledge Knowledge management features Definition of KM: It Secures & distributes knowledge in order to assure and optimise its availability Aims of KM: - Keeping knowledge up to date & correct - Providing knowledge in the right location - Applying knowledge of the most suitable type - Providing knowledge at the time of need ٢۶ ١٣

14 Managing medical knowledge Motivations for implementing KM strategy within an organisation: - To keep track of an expert s know-how, even if s/he moves or retires - To enable an intelligent consultation in order to exploit successes & mistakes experienced - To keep histories for new staffs and not decrease quality of work by changes in staffs - To improve knowledge communication - To improve learning of inexpert and new personnel ٢٧ Managing medical knowledge Advantages of KM: - A proper KM strategy allows for a continuous quality improvement based on performance measurement and data analysis - A careful data analysis may be a very effective way to identify problems in routine work and to provide directions to recognise medical services - Motivate t further investigations on the neglected or unobserved variables -Invaluable source for planning organisational interventions ٢٨ ١۴

15 Managing medical knowledge Knowledge management in the medical domain: the nature of medical knowledge Features of implicit KM: - Very useful for sharing other clinicians experiences - Needs individual ability of making inferences and of coping with the problem - Uses physician s i personal way of organising i the reasoning process ٢٩ Managing medical knowledge Features of explicit KM: - Formulating a hypothesis about the correct diagnosis or therapy - Then in proving on the basis of additional observations - Rely on data & prior domain knowledge to make the possible diagnostic explanation or therapeutic advice ٣٠ ١۵

16 Managing medical knowledge An efficient KM approach is a valuable way for helping exploiting all the available knowledge sources ٣١ Managing medical knowledge CBR- case based reasoning - for implicit type RBR- rule based reasoning - for explicit type MMR- multi modal reasoning - integrates CBR and RBR ٣٢ ١۶

17 Managing medical knowledge Reasoning Paradigm ٣٣ Conclusion MMR methodology seems to be a valuable way for exploiting all the knowledge available within the organisation for: - Mining and intelligently retrieving it - Distributing it among different health care providers -To optimise the processes of patients management and therapy revision DSS cannot be conceived as an independent tool. It should be optimised by integrating with KM ٣۴ ١٧

18 Nurse & Technology Interaction Computer Technology Acceptation Practice Management Education Research ٣۵ Nurse & Technology Interaction in the medical domain, different knowledge types are typically available: - Operative knowledge - Formalized knowledge Since 30 years ago, expert systems has been defined to help physicians solve particularly critical decision problems On field exploitation of ES were poor, due to: - poor usability, accessibility & organizational factors - stand alone situation ٣۶ ١٨

19 Nurse & Technology Interaction Today the trend in definition of DSS is integration of HIS with different methodologies & technologies This goal is achieved by integrating the decision support functionality with the knowledge management (KM) task IT allows to face simple, but large scale problems ٣٧ Nurse & Technology Interaction Interactive transfer of expertise nurse & computer program guide knowledge acquisition process ٣٨ ١٩

20 Nurse & Technology Interaction Nursing Information Systems Electronic Health Report Systems Patient Digital Assistant Medical Diagnosis Systems ٣٩ Honeywell HomMed Products ۴٠ ٢٠

21 Nurse & Technology Interaction Home care Tele-Nursing Database E-Learning Educational-PDA E-Shift Scheduling ۴١ Conclusion Nursing informatics implementation depends on three factors: Individual ۴٢ ٢١

22 Conclusion Information Management Framework Computer Skills Informatics Knowledge Informatics Skills Informatics Competencies Human Information processing Skills Information Management Competencies ۴٣ Conclusion Reasons for IT adoption failures Factors influencing IT adoption Nurses are integrated to Technology in its all aspects ۴۴ ٢٢

23 references Guenther JT, Peters M,.Mapping the literature of nursing informatics, Medical Library Association, 2006: 94(2) Staggers N, Gassert CA, Curran C, A Delphi Study to Determine Informatics Competencies for Nurses at Four Levels of Practice, NURSING RESEARCH, 2002: 51(6) lee TT, Nursing administrators' experiences in managing PDA use for inpatient units, CIN, 2006:24(5) Bangert AW, Easterby L, Designing and delivering effective online nursing courses with the evolve electronic classroom, CIN, 2008:26(2) Darvish A, Salsali M, "A review on information technology development and the necessity of -nursing informatics specialty", INTED2010 (International Technology, Education and Development Conference), 8-10 March 2010, Valencia, Spain. Virtual Presentation Ammenwerth E, Iller C, Mahler C, IT-adaption and the interaction of task, technology and individuals: a fit framework and a case study, BMC Med Inform Decis Mak, 2006: 6(3) ۴۵ Next session effective internet search: key points ۴۶ ٢٣