NURSING INFORMATICS BOOK .pdf - ANA Standards of Nursing Informatics Practice The Standards of Practice for Nursing Informatics describe a competent

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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 1 1 1 2 2 6 7 8 9 14 14 16 18 19 21 22 24 24 26 27 29 30 31 32 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 36 37 37 39 40 40 40 40 41 41 41 43 43 44 46 47 48 48 49 52 52 53 54 54 55 57 57 59 59 60 60 62 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 64 65 65 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 67 68 68 70 71 72 73 75 76 77 78 79 79 81 83 84 86 87 89 91 92 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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