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Unformatted text preview: ANA Standards of Nursing Informatics Practice
The Standards of
Practice for Nursing
Informatics describe a
competent level of nursing
care as demonstrated
by the critical thinking
model known as the
nursing process. The
nursing process includes
the components of
assessment, diagnosis,
outcomes identification,
planning, implementation,
and evaluation.
Accordingly, the nursing
process encompasses
significant actions taken
by nursing informatics
nurses and forms the
foundation of the nurse’s
decision-making. Standards of Practice for
Nursing Informatics Nursing
Standard 1. Assessment The informatics nurse collects comprehensive data,
information, and emerging evidence pertinent to the situation. Standard 2. Diagnosis, Problems, and
Issues Identification The informatics nurse analyzes assessment data to
identify diagnoses, problems, issues, and opportunities for
improvement. Standard 3. Outcomes Identification The informatics nurse identifies expected outcomes for a plan
individualized to the healthcare consumer or to the situation. Standard 4. Planning The informatics nurse develops a plan that prescribes strategies,
alternatives, and recommendations to attain expected outcomes. Standard 5. Implementation The informatics nurse implements the individualized plan. Standard 5A. Coordination of Activities The informatics nurse coordinates planned activities. Standard 5B. Health Teaching and Health
Promotion The informatics nurse employs informatics solutions and
strategies for education and teaching to promote health
and a safe environment. Standard 5C. Consultation The informatics nurse provides consultation to influence
the identified plan, enhance the abilities of others, and
effect change. Standard 6. Evaluation The informatics nurse evaluates progress toward attainment
of outcomes.
© 2015 ANA source: American Nurses Association (2015). Nursing Informatics: Scope and
Standards of Practice, 2nd Edition. Silver Spring, MD: Nursesbooks.org. Nursing
Informatics:
Scope and
Standards
of Practice
Second Edition American Nurses Association
Silver Spring, Maryland
2015 The American Nurses Association (ANA) is a national professional association. This publication, Nursing
Informatics: Scope and Standards of Practice, Second Edition, reflects the thinking of the practice
specialty of nursing informatics on various issues and should be reviewed in conjunction with state
board of nursing policies and practices. State law, rules, and regulations govern the practice of nursing,
while Nursing Informatics: Scope and Standards of Practice, Second Edition, guides informatics nurses
in the application of their professional skills and responsibilities.
The American Nurses Association is the only full-service professional organization representing the
interests of the nation’s 3.1 million registered nurses through its constituent/state nurses associations
and its organizational affiliates. The ANA advances the nursing profession by fostering high standards
of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic
view of nursing, and by lobbying the Congress and regulatory agencies on healthcare issues affecting
nurses and the public. American Nurses Association
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910-3492
1-800-274-4ANA
Published by Nursesbooks.org
The Publishing Program of ANA
Copyright © 2015 American Nurses Association. All rights reserved. Reproduction or transmission in
any form is not permitted without written permission of the American Nurses Association (ANA).
This publication may not be translated without written permission of ANA. For inquiries, or to report
unauthorized use, email [email protected]
ISBN-13: 978-1-55810-580-5
First printing: November 2014. SAN: 851-3481 11/2014 Contents Contributors The Scope of Nursing Informatics Practice Introduction Definition of Nursing Informatics Metastructures, Concepts, and Tools of Nursing Informatics Metastructures: Data, Information, Knowledge, and Wisdom Integration of Nursing Informatics into Practice Nursing Informatics Practice Tenets of Nursing Informatics Nursing, the Nursing Process, and Vocabularies Concepts and Tools from Information Science and Computer Science User Experience and Related Concepts Phenomenon of Nursing Functional Areas of Nursing Informatics Administration, Leadership, and Management Systems Analysis and Design Compliance and Integrity Management Consultation Coordination, Facilitation, and Integration Development of Systems, Products, and Resources Education and Professional Development Genetics and Genomics Information Management and Operational Architecture Policy Development and Advocacy Quality and Performance Improvement Research and Evaluation vii
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32 iii Contents Safety, Security, and Environmental Health Integrated Functional Area Example: Telehealth and Informatics Evolution of Informatics Competencies Informatics Competencies Requisite for All Registered Nurses Research About Nursing Informatics Competencies Professional Organization Discussions on Informatics Competencies Healthcare Leadership Alliance American Organization of Nurse Executives Quality and Safety Education for Nurses National League for Nursing TIGER Initiative Foundation Informatics Competencies: Spanning Careers and Roles Informatics Competencies for Informatics Nurses and Informatics
Nurse Specialists Informatics Competencies for Nurse Educators Office of the National Coordinator for Health Information Technology Synthesis of Evolution of NI Competencies Preparation for Nursing Informatics Specialty Practice Certification of Informatics Nurses An Advancing Professional Nursing Specialty Ethics in Nursing Informatics The Future of Nursing Informatics Trends in Practice Roles and Competencies for Nurses and Informatics Trends in Technology Nanotechnology Tools for Managing Population Health Concerns Devices and Hardware Robotics Focus of Emerging Technologies Knowledge Representation Educational Technologies Tools for Patient Access to Health Information Expanded Use of IT in Nursing Implications for Nursing Informatics Trends in Regulatory Changes and Quality Standards iv 34
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62 Nursing Informatics: Scope and Standards of Practice, 2nd Edition Contents Trends in Care Delivery Models and Innovation Consumer Informatics External Partnerships Implications for Nursing Informatics NI Future and Trends: Summary 63
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66 Standards of Nursing Informatics Practice Significance of the Standards Standards of Practice for Nursing Informatics Standard 1. Assessment Standard 2. Diagnosis, Problems, and Issues Identification Standard 3. Outcomes Identification Standard 4. Planning Standard 5. Implementation Standard 5a. Coordination of Activities Standard 5b. Health Teaching and Health Promotion Standard 5c. Consultation Standard 6. Evaluation Standards of Professional Performance for Nursing Informatics Standard 7. Ethics Standard 8. Education Standard 9. Evidence-Based Practice and Research Standard 10. Quality of Practice Standard 11. Communication Standard 12. Leadership Standard 13. Collaboration Standard 14. Professional Practice Evaluation Standard 15. Resource Utilization Standard 16. Environmental Health 67
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93 Glossary 95 References 97 Appendix A. An Emerging Model of Wisdom 107 Appendix B. Nursing Informatics: Scope and Standards of Practice
(2008) 109
Index Nursing Informatics: Scope and Standards of Practice, 2nd Edition 205 v This page intentionally left blank Contributors Work Group Members
William Donovan, MA, RN, Chairperson
Linda Dietrich, MSN, RN-BC, PMP, CPHQ
Sandra Blair Ekimoto, MBA, BS, RN
Paulette Fraser, MS, RN-BC
Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR
Linda Harrington, PhD, DNP, RN-BC, CNS, CPHQ, CENP, CPHIMS,
FHIMSS
Luann Whittenburg, PhD, RN-BC, FNP-BC, CPHQ, CPHIMS
Kathleen “Katie” Hoy Johnson, DNP, RN-BC, NCSN
Mary Lynn McHugh, PhD, RN
Leigh Ann Chandler Poole, PhD, RN, FNP-BC, CRNP, CTCP, CTC
Cheryl D. Parker, PhD, RN-BC, FHIMSS
Troy Seagondollar, MSN-I, RN-BC
Nadia Sultana, DNP, MBA, RN-BC Advisory Group Members
Theresa L. Calderone, EdD, Med, MSN, RN-BC
Lory J. Maddox, MSN, MBA, RN
Susan A. Matney, MSN, RN, FAAN
Darla Shehy, MSN, RN
Rhonda Struck, BSN, RN, MS vii Contributors American Nurses Association Staff
Carol Bickford, PhD, RN-BC, CPHIMS, FAAN
Maureen Cones, Esq.
Eric Wurzbacher, BA
Yvonne Humes, MSA About the American Nurses Association
The American Nurses Association (ANA) is the only full-service professional
organization representing the interests of the nation’s 3.1 million registered
nurses through its constituent/state nurses associations and its organizational
affiliates. The ANA advances the nursing profession by fostering high standards
of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and
regulatory agencies on healthcare issues affecting nurses and the public. About Nursesbooks.org, The Publishing
Program of ANA
Nursesbooks.org publishes books on ANA core issues and programs, including
ethics, leadership, quality, specialty practice, advanced practice, and the profession’s enduring legacy. Best known for the foundational documents of the
profession on nursing ethics, scope and standards of practice, and social policy,
Nursesbooks.org is the publisher for the professional, career-oriented nurse,
reaching and serving nurse educators, administrators, managers, and researchers as well as staff nurses in the course of their professional development. viii Nursing Informatics: Scope and Standards of Practice, 2nd Edition The Scope of Nursing
Informatics Practice
Introduction
The American Nurses Association (ANA) identified nursing informatics as a
nursing specialty in 1992. The first scope of practice statement for this specialty,
Scope of Practice for Nursing Informatics, was published in 1994, followed
by the 1995 release of an accompanying resource, Standards of Practice for
Nursing Informatics. Those early publications were replaced in 2001 by the
Scope and Standards of Nursing Informatics Practice, which combined both the
scope and standards of practice into one document and created an enhanced
and more robust definition of nursing informatics to reflect the contemporary
healthcare informatics environment. The 2008 Nursing Informatics: Scope
and Standards of Practice followed with a slightly revised specialty definition
of nursing informatics and inclusion of an expanded presentation of competencies for the informatics nurse and informatics nurse specialist.
The publication of this second edition of Nursing Informatics: Scope and
Standards of Practice is the culmination of an 18-month-long intensive professional review and revision initiative hosted by ANA. Dedicated workgroup
members with more than 280 person-years of nursing and informatics expertise met at least twice a month via telephone conference calls from April 2013
until the final draft was completed in July 2014. Weekly meetings became the
norm as the workgroup members evaluated every response received from the
30-day public comment period. The final draft completed a two-step ANA
review process with examination by the ANA Committee on Nursing Practice
Standards and final approval by the Board of Directors. Definition of Nursing Informatics
Nursing informatics (NI) is the specialty that integrates nursing science with
multiple information and analytical sciences* to identify, define, manage, and
* A listing of sciences that integrate with nursing informatics includes, but is
not limited to: computer science, cognitive science, the science of terminologies and taxonomies (including naming and coding conventions), information
management, library science, heuristics, archival science, and mathematics. 1 The Scope of Nursing Informatics Practice communicate data, information, knowledge, and wisdom in nursing practice.
NI supports nurses, consumers, patients, the interprofessional 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, information processes, and information technology.
The nursing informatics specialty and its constituent members contribute to
achieving the goal of improving the health of populations, communities, groups,
families, and individuals. Supporting activities include, but are not limited to,
the identification of issues and the design, development, and implementation
of effective informatics solutions and technologies within the clinical, administrative, educational, and research domains of practice. Metastructures, Concepts, and
Tools of Nursing Informatics
Metastructures: Data, Information, Knowledge,
and Wisdom
In the mid-1980s, Blum (1986) introduced the concepts of data, information, and
knowledge as a framework for understanding clinical information systems and
their impact on health care. Blum classified clinical information systems according to the three types of objects that these systems processed: data, information,
and knowledge. Blum noted that the classification was artificial, with no clear
boundaries, although the categories did represent a scale of increasing complexity.
In 1989, Graves and Corcoran built on these ideas in their seminal study
of nursing informatics using the concepts of data, information, and knowledge. They contributed two general principles to NI: a definition of nursing
informatics that has been widely accepted in the field, and an information
management model that identified data, information, and knowledge as key
components of NI practice (Figure 1).
Drawing from Blum’s 1986 work, Graves and Corcoran defined the three
concepts as follows:
are discrete entities that are described objectively without
interpretation. ■ Data ■ Information is data that have been interpreted, organized, or structured. is information that is synthesized so that relationships are
identified and formalized. ■ Knowledge 2 Nursing Informatics: Scope and Standards of Practice, 2nd Edition The Scope of Nursing Informatics Practice Management
processing Data Information Knowledge Figure 1. Conceptual Framework for the Study of Nursing Knowledge
Source: Graves & Corcoran (1989). Reprinted with permission of the publisher. Data, information, and knowledge are of value to nurses in all areas of practice. Data may be obtained from multiple sources; the data are processed into
information and then into knowledge. For example, data derived from direct
care of an individual can be compiled across disease states and then aggregated
for decision-making by nurses, nurse administrators, or other health professionals. Further aggregation can encompass geographical populations. Nurse
educators can create case studies using these data, and nurse researchers can
access the aggregated data for systematic study.
The appropriate use of knowledge involves the integration of empirical, ethical, personal, and aesthetic knowledge into actions. The individual must apply
a high level of empirical knowledge in understanding the current situation,
apply a professional value system in considering possible actions, be able to
predict the potential outcome of these actions with a high level of accuracy, and
then have the means to carry out the selected action in the given environment.
Wisdom is defined as the appropriate use of knowledge to manage and solve
human problems. It consists of knowing when and how to apply knowledge
to deal with complex problems or specific human needs (Nelson & Joos, 1989;
Nelson, 2002; Nelson & Staggers, 2014). Whereas knowledge focuses on what
is known, wisdom focuses on the appropriate application of that knowledge
and an appreciation of the consequences of selected actions. For example, a
knowledge base may include several options for managing an anxious family;
wisdom involves nursing judgment about which of these options is most appropriate for a specific family, and use of that option in the care of that family.
An example can help distinguish data, information, knowledge, and wisdom. If a nurse receives the list of numbers, 28, 68, 94, 98, and 110, those
raw numbers are certainly data, but they are meaningless. If, however, the
numbers are ordered, structured, and identified as follows: T 98o, P 94, R 28, and BP 110/68, the nurse recognizes this series as measurements of vital
signs and will regard those numbers as information. Nevertheless, the nurse Nursing Informatics: Scope and Standards of Practice, 2nd Edition 3 The Scope of Nursing Informatics Practice must be able to place these measures in the context of a particular patient’s situation in order to interpret the meaning of those values. If these vital signs were
obtained from a newborn, they mean one thing; if they were obtained from an
adult, they have a very different meaning. The nurse’s knowledge of normal vital
sign values for different types of patients, and the condition of the patient from
whom the numbers were obtained, provide a context within which the nurse can
interpret the information. Then the nurse will know if the numbers represent a
normal, expected result or an abnormal, even pathological result. The numbers
must be placed in a particular context so that the nurse can take appropriate
clinical action, thereby demonstrating “knowledge-in-use” or wisdom.
Figure 2 builds on the work of Graves and Corcoran by depicting the
relationship of data, information, knowledge, and wisdom. As data are Increasing complexity Wisdom
Understanding,
applying, and
applying with
compassion
Constant flux Knowledge
Interpreting,
integrating, and
understanding Information
Organizing and
interpreting Data
Naming, collecting,
and organizing Increasing interactions and interrelationships Figure 2. The Relationship of Data, Information, Knowledge, and Wisdom
(Copyright 2002 Ramona Nelson, Ramona Nelson Consulting. All rights reserved. Reprinted with permission.) 4 Nursing Informatics: Scope and Standards of Practice, 2nd Edition The Scope of Nursing Informatics Practice Increasing complexity Wisdom
Understanding,
applying,
integrating service
with compassion
Knowledge
Interpreting,
integrating,
understanding Constant flux Information
Organizing,
interpreting Data
Naming, collecting,
and organizing Increasing interactions and interrelationships Figure 3. Revised Data Information Knowledge Wisdom (DIKW) Model—2013 Version
(© 2013 Ramona Nelson, Ramona Nelson Consulting. All rights reserved. Reprinted with permission.) transformed into information and information into knowledge, each level
increases in complexity and requires greater application of human intellect. The
x-axis represents interactions within and the interrelationships between the
concepts as one moves from data to wisdom; the y-axis represents the increasing complexity of the concepts.
Figure 3 reflects Nelson’s recent evolution of her 2002 model depicting
the dynamic interactivity of the inter- and intra-environmental factors that
influence the movement across and within the data-to-wisdom continuum.
In a newly published model, Nelson identifies how information, decision
support, and expert systems represent and enable the evolution of data to
information to knowledge to wisdom (Figure 4). For some additional details
on an emerging wisdom model, see Appendix A. Nursing Informatics: Scope and Standards of Practice, 2nd Edition 5 The Scope of Nursing Informatics Practice Increasing complexity Wisdom
Understanding,
applying, integrating
service with
compassion Knowledge
Interpreting,
integrating,
understanding
Information
Organizing,
interpreting
Data
Naming, collecting,
organizing Expert
system Decision
sup...
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