2009 The elearning Institute. All rights reserved.

2009 The elearning Institute. All rights reserved.

Educational Issues in Nursing Informatics Jennie C. De Gagne, PhD, MSN, MS, RN-BC, CNE Assistant Professor North Carolina Central University Durham, NC ABSTRACT The knowledge of health information management is necessary for every healthrelated discipline. Caring for patients at bedside and working closely with other healthcare professionals, nursing students must be prepared to meet the demands of the ever-changing healthcare environment. Aligning with the meaningful use initiative and meeting students educational and consumers healthcare needs, nursing faculty should keep abreast of current trends and developments in nursing informatics. The purpose of this article is to address the importance of informatics in entry-level nursing program curriculum and to propose ways for faculty development in this area. 1

Background New nurse graduates, regardless of their practice setting, must develop technology literacy and health information management skills (American Nurses Association [ANA], 2008). The National Advisory Council on Nurse Education and Practice (2010) supports the ANA s statement, contending that nursing students must attain knowledge and skills in managing large amounts of information during school years. In order to meet current trends and innovations in health information technology, nurse educators who work in academic settings have responsibilities to integrate such knowledge and skills into their curriculum. At the same time, they must be knowledgeable and experienced in this field through continuous education. Unfortunately, there is a gap between the classroom and the real world in that new graduates have difficulties keeping pace with rapid advances in new technologies. Additionally, nursing faculty have not reached the consensus on how to best establish informatics content in the curriculum to provide future nurses with relevant real-world competencies. To make situations worse, many of them lack necessary knowledge and skills to appropriately and sufficiently address the curriculum revision (Fetter, 2009). The purpose of this article is to address the importance of informatics to nursing, the needs for faculty development in this area, and the necessity to embrace the concept of informatics in an entry level nursing curriculum. While understanding obstacles such as workload and time constraints of nursing faculty to seek formal training in informatics, available resources with regard to continuing education and networking opportunities will also be discussed. Importance of Informatics to Nursing Patient Safety 2

The healthcare system in the United States (U.S.) has become increasingly complex while the use of computers in health care expanded. Focused on information management and communication, not on computers, nursing informatics became necessary for nurses to improve the health of populations (Saba, Skiba, & Bickford, 2004). Patient safety is a priority for health systems, professionals, and consumers around the world, not only in the U. S. In 2004, the World Health Organization (Joint Commission International Center for Patient Safety, 2007) initiated the World Alliance for Patient Safety, addressing 10 major action issues, including a focus on new technologies as a means to improve patient safety. The Institute of Medicine (IOM, 1999) reported 44,000 to 98,000 deaths per year in U. S. hospitals due to medication errors, recommending that technologies should be used in order to prevent adverse drug interactions, inappropriate doses, potential side effects, and other types of errors. Involved in care at all levels, nurses are committed to patient safety initiatives (Manno, Hogan, Heberlein, Nyakiti, & Mee, 2006). To fulfill such commitment, nurses must be equipped with skills on how to collect and use comprehensive data, information, and knowledge pertinent to the situation and on how to analyze the assessment data to determine the problems (ANA, 2008). Without such skills or competencies, their commitment for patient safety is hard to turn into concrete actions in this complex medical setting. Hence, informatics needs to be taught early on so nurses can properly use the healthcare system to enhance patient safety. Demands for Consumer Transparency There is widespread concern that the current healthcare system cannot be sustained unless immediate action is taken. The Bush administration set 2014 as a target for the adoption of electronic health records (EHR) to facilitate comparisons of quality and cost of care (Hebda & Czar, 2009). The Leapfrog Group (2007), an organization that advocates quality of care through 3

technology, has advocated changes in the healthcare delivery system by promoting a computerized physician order entry (CPOE). The Institute for Safe Medication Practices (2007) has also been working on the compilation of a list of error-prone abbreviations, symbols, and dose designations that should be avoided in any communications among healthcare providers. Despite these endeavors, a number of consumers are still unable to compare the quality and cost of care to make informed decisions (Hebda & Czar, 2009). Healthcare costs can be driven by the move towards informatics (Hebda & Czar, 2009). For example, supported by the Robert Wood Johnson Foundation, the Leapfrog Group (2007) strives for improvements of safe, high quality, and affordable healthcare services through the information technology. One of the missions of the Leapfrog Group is to assess hospitals progress on the National Quality Forum, which can be put forth by collecting data and posting it on a Web site where consumers can check the outcomes of hospitals in their areas (Hebda & Czar, 2009). Healthcare providers with improper information systems put in place will be challenged by today s consumers who are more sophisticated and knowledgeable about technologies and who demand better consumer transparency. Any health profession that is not ready for meeting consumers needs may find itself lost in the process. All nurses must understand the value of nursing data; they need to know how to obtain it, the terminology needed to access it, and the methods for analyzing and making decisions based on data. Undoubtedly, nursing informatics will be a critical part of the systems and processes on which the healthcare information technology relies (Thede & Sewell, 2010). Informatics in the Nursing Curriculum Nursing students are being increasingly exposed to health information technology such as EHRs, handheld computers, barcode medication dispensing systems, and automatic capture of 4

patient data (Lee, 2007). While many studies have reiterated the importance of student exposure to such technologies, nursing faculty are reticent to incorporate informatics within the curriculum due to unfamiliarity with technologies (Bakken et al., 2004). In spite of the studies to determine informatics competencies that should be included in an entry-level nursing program, confusion still exists regarding whether computer skills, such as spreadsheet and presentation software, are a competency and whether such skills should be a prerequisite for admission to a nursing program or a competency to be developed through the curriculum (Fetter, 2009). In 2008, the National League for Nursing (NLN) reported that 65% of the nursing schools incorporated informatics concepts in their programs, whereas only 23% of the schools offered informatics courses in baccalaureate nursing curriculum. However, the extent and content under which it should be incorporated into the curriculum is unknown. Furthermore, most pre-licensure nursing students are rarely exposed to the concepts of standardized terminologies and interoperability as they are usually dealt in nursing informatics graduate programs (Courtney, Goodwin, Aubrecht, 2011). It is, however, argued that these concepts must be introduced to pre-licensure nursing students before they become registered nurses given that their awareness or exposure to such concepts may entail important implications and directions for generalist nurses on the very first day of nursing practice, not necessarily only for nurses specializing in informatics. A database management system is an application program that provides the tools for creating a database, entering data, retrieving, manipulating, and reporting information contained within the data (Thede & Sewell, 2010, p. 178). Computers are an essential tool in this process, and several levels of personnel, including bedside nurses who work in direct patient care in hospitals or long-term care, must collaborate through the system. These bedside nurses often 5

assume a simultaneous role as a decision-maker and as a patient advocate. They continuously gather nursing data during the nursing practice through observation and nurse-patient interactions. The ability to understand basic database terminology, structure, and concepts will be beneficial, in fact required, for bedside information processing and communications among interdisciplinary team members. To attain this ability during a nursing program, students must learn how database systems are built, used, and managed while becoming familiarized with at least nursing classification languages and a standardized clinical terminology that is used by healthcare providers for exchanging clinical health information. At present, nursing informatics is an emerging field of study, which is mostly dealt with by graduate programs. Considering the rapid growth in healthcare information systems, nursing faculty must be proficient in this area to be better role models for students. Continuing Education and Networking for Nursing Faculty Continuing education on recent technological advances is of great importance (Curran, 2008). In reality, faculty members are expected to teach in informatics areas in which they have little knowledge and experience. Indeed, a study showed that faculty had to learn by themselves to teach telehealth despite being novices in the field (Gallagher-Lepak, Scheibel, & Gibson, 2009). Although seeking formal education (e.g., master s degree, certificate programs, or doctoral programs) in informatics may be ideal to be proficiently ready for teaching, this option may not always be feasible for many of them due to heavy workloads and time constraints. Some options to overcome such obstacles would be to join informatics organizations to keep up-to-date with current trends, developments, and best practices. For example, faculty can get involved in local, regional, national, international, or even virtual informatics organizations. At the local level, they can network and share information; the North Carolina Nurses Association (NCNA) 6

Council on Nursing Informatics (CoNI) develops and provides informatics continuing education (NCNA, 2011). Regional and national organizations, such as the American Nursing Informatics Association Capital Area Roundtable on Informatics in Nursing (ANIA-CARING: http://www.ania-caring.org), hold annual conferences with nationally well-renowned guest speakers, partner with publishers to provide journal articles, and administer listserv to pose questions and share information about initiatives and activities members facility or state has undertaken. Whether for a formal program or networking organizations, educational activities are necessary for current nursing faculty to better serve their students and to respond to the health needs of their citizens. Nursing administration s support to such endeavors will be an indispensable part of the faculty development process. Conclusion This article has highlighted the importance of informatics in nursing, the needs for curriculum revision or innovation and ways of faculty development in nursing informatics. While there was some disagreement about what constituted informatics competencies and knowledge for pre-licensure nursing students, basic concepts in health informatics were recommended for curriculum inclusion in entry-level nursing programs. Faculty development and administration support cannot be overemphasized in the advancement of nursing students informatics and technology competencies. However, prior to undertaking a curriculum change, faculty and administrators must have a genuine interest and commitment in this field. Although the foundation is in place, there is a need for further discussions on nursing informatics education in the pre-licensure curriculum and its impact on patient care outcomes. 7

References American Nurses Association. (2008). Scopes and standards of nursing informatics practice. Washington, DC: Author. Bakken, S., Cook, S. S., Curtis, L., Desjardins, K., Hyun, S., Jenkins, M.,... Soupios, M. (2004). Promoting patient safety through informatics-based nursing education. International Journal of Medical Informatics, 71, 581-589. Courtney, K. L., Goodwin, L. K., & Aubrecht, J. (2011). Database management systems Their place in nursing informatics education. CIN Plus, 29(1), 7-12. Curran, C. R. (2008). Faculty development initiatives for the integration of informatics competencies and point-of-care technologies in undergraduate nursing education. Nursing Clinics of North America, 43(4), 523-533. Fetter, M. S. (2009). Curriculum strategies to improve baccalaureate nursing information technology outcomes. Journal of Nursing Education, 48(2), 78-85. Gallagher-Lepak, S., Scheibel, P., & Gibson, C. C. (2009). Integrating telehealth in nursing curricula: Can you hear me now? Online Journal of Nursing Informatics, 13(2), 1-16. Hebda, T., & Czar, P. (2009). Handbook of informatics for nurses & healthcare professionals. Upper Saddle River, NJ: Pearson. Institute for Safe Medication Practices. (2007). Error-prone conditions that lead to student nurserelated errors. Medication Safety Alert, 12, 1 3. Retrieved from http://www.ismp.org/newsletters/acutecare/articles/20071018.asp Institute of Medicine. (1999). To err is human: Building a safer health system. Washington, DC: National Academy Press. 8

Joint Commission International Center for Patient Safety. (2007). World Alliance for Patient Safety. Retrieved from http://www.who.int/patientsafety/worldalliance/en/ Leapfrog Group. (2007). How & Why Leapfrog Started. Retrieved from http://www.leapfroggroup.org/about_us Lee, T. T. (2007). Nurses experiences using a nursing information system: Early stage of technology implementation. CIN: Computers, Informatics, Nursing, 25 (5), 294 300. Manno, M., Hogan, P., Heberlein, V., Nyakiti, J., & Mee, C. L. (2006). Patient-safety survey report. Nursing, 36(5), 54-64. National Advisory Council on Nurse Education and Practice [NACNEP]. (2010). Addressing new challenges facing nursing education: Solutions for a transforming healthcare environment. Retrieved from http://bhpr.hrsa.gov/nursing/nacnep/reports/eighth.pdf National League for Nursing (NLN) Board of Governors. (2008). Position statement: Preparing the next generation of nurses to practice in a technology-rich environment: An informatics agenda. Retrieved from http://www.nln.org/aboutnln/positionstatements/informatics_052808.pdf North Carolina Nurses Association. (2011). Welcome to nursing informatics! Retrieved from http://www.ncnurses.org/practice_coni/practice_coni_home.asp Saba, V. K., Skiba, D. J., & Bickford, C. (2004). Competencies and credentialing: Nursing informatics. In E. J. S. Hovenga & J. Mantas (Eds.), Global Health Informatics Education (pp. 75-89). Amsterdam, Netherlands: IOS Press. Thede, L. Q., & Sewell, J. P. (2010). Informatics and nursing: Competencies and applications. Philadelphia, PA: Wolters Kluwer. 9

Author Information. Dr. Jennie De Gagne is Assistant Professor of the Department of Nursing at North Carolina Central University. She studied in Nursing in South Korea and earned two masters in Health Psychology and Nursing Education in the States. She received her PhD from Northcentral University in Arizona in Education with emphasis on Education Technology Management. Dr. De Gagne has 20 years of nursing experience and has worked in a wide variety of settings, including primary care, case management, staff development, administration, and continuing education. She has served as a planning committee member and a faculty member for a Faculty Development in Health Literacy and Aging (FDHLA) program at the Carolina Geriatric Education Center, UNC Chapel Hill, School of Medicine. Dr. De Gagne also serves as a consultant for the Duke Geriatrics Education Center (GEC). As a postgraduate fellow at the Stanford University School of Medicine SGEC's Mini- Fellowship in Ethnogeriatric, Dr. De Gagne is actively involved in research activities related to the study of Ethnogeriatrics and Health Literacy, as well as in Nursing Education. Her research area of interest and professional experience include minority groups' health disparities and nursing education using educational technologies. Dr. De Gagne is a member of several professional organizations such as American Nurses Association, Honor Society in Education, Southern Nursing Research Society, and National Gerontological Nursing Association. She is also the founder of North Carolina Korean Nurses Association, editor of the Journal of Health Sciences & Practice (JOHSP) at the elearning Institute (http://theelearninginstitute.org), and a global ambassador for the Sigma Theta Tau International Honor Society of Nursing. She has been a recipient of scholarships and awards throughout her professional and academic tenure, being interviewed nationally and internationally for print and the web. 10