THE PRACTICE SPECIALTY OF NURSING INFORMATICS (1/2)

Introduction
1. Decision making is an integral part of daily life
2. Nurses regularly make frequent, critical, life-impacting decisions
3. Good decisions require accurate and accessible data as well as skill in processing information
4. At the heart of nursing informatics is the goal of providing nurses with the data, information, and support for
information processing to make effective decisions
5. This decision making can encompass any and all of the following areas of nursing practice
 Client care
 Research
 Education
 Administration

Informatics Nurse/Informatics Nurse Specialist

1. An informatics nurse (IN) is a registered nurse who has experience in nursing informatics
2. Informatics nurse specialists (INS) are prepared at the graduate level (master’s degree) with specialty courses in
nursing informatics
3. An INS functions as a graduate-level-prepared specialty nurse

Foundational documents Guide nursing Informatics Practice

1. Nursing informatics practice and the development of this specialty has been guided by several foundational
documents
 Code of Ethics for Nurses With Interpretive Statements (2001)
 Nursing’s Social Policy Statement, Second Edition (2003)
 Nursing’s Social Policy Statement: The Essence of the Profession (2010)
 Nursing: Scope and Standards of Practice, Second Edition (2010)
2. In 2001, the American Nurses Association (ANA) published the Code of Ethics for Nurses with Interpretive
Statements
 A complete revision of previous ethics provisions and interpretive statements that guide all nurses in
practice
 Be it in the domains of direct patient care, education, administration, or research
3. Nurses working in the informatics specialty are professionally bound to follow these provisions
4. Terms such as:
 Decision making
 Comprehension
 Information
 Knowledge
 Shared goals
 Outcomes
 Privacy
 Confidentiality
 Disclosure
 Policies
 Protocols
 Evaluation
 Judgment
 Standards
 Factual documentation abound throughout the explanatory language of the interpretive statements
5. In 2003, a second foundational professional document, Nursing’s Social Policy Statement, Second Edition
 Provided a new definition of nursing that was reaffirmed in the 2010 Nursing’s Social Policy Statement:
The Essence of the Profession
  Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in
the care of individuals, families, communities, and populations
6. The ANA’s Nursing: Scope and Standards of Practice, Second Edition, further reinforces the recognition of
nursing as a cognitive profession
7. The exemplary competencies accompanying each of the 16 Standards of Professional Nursing Practice,
comprised of Standards of Practice and Standards of Professional Performance, reflect the:
 Specific knowledge
 Skills
 Abilities
 Judgment capabilities expected of registered nurses
8. The standards include:
 Data
 Information
 Knowledge management activities as core work for all nurses
9. This cognitive work begins with the critical-thinking and decision-making components of the nursing process
that occur before nursing action can begin
10. The nursing process provides a delineated pathway and process for decision making
 Assessment, or data collection and information processing, begins the nursing process
 Diagnosis or problem definition, the second step, reflects the interpretation of the data and information
gathered during the assessment
 Outcomes identification is the third step, followed by planning as the fourth step
 Implementation of a plan is the fifth step
 The final component of the nursing process is evaluation
 The nursing process is most often presented as a linear process with evaluation listed as the last step
 The nursing process really is iterative, includes numerous feedback loops, and incorporates evaluation
activities throughout the sequencing
11. The collection of data about a client or about a management, education, or research situation is guided by a
nurse’s knowledge base built on
 Formal and informal educational preparation
 Evidence and research
 Previous experiences
12. In healthcare, data, information, and knowledge are growing at astronomical rates and demand increasing
reliance on computer and information systems for
 Collection
 Storage
 Organization and management
 Analysis
 Dissemination
13. Nursing informatics is the nursing specialty that endeavors to make the
 Collection
 Management
 Dissemination of data, information, and knowledge—to support decision making—easier for the
practitioner, regardless of the domain and setting

Informatics and Healthcare Informatics

1. Informatics is a science that combines
 A domain science
 Computer science
 Information science
 Cognitive science
2. It is a multidisciplinary science, drawing from varied theories and knowledge applications
 3. Healthcare informatics may be defined as the integration of
 Healthcare sciences
 Computer science
 Information science
 Cognitive science to assist in the management of healthcare information
4. Healthcare informatics is a subset of informatics
5. Because healthcare informatics is a relatively young addition to the informatics umbrella, you may see other
terms that seem to be synonyms for this same area, such as
 Health informatics
 Or medical informatics
6. Medical informatics, historically, was used in Europe and the United States as the preferred term for healthcare
informatics
7. Now, medical informatics is more clearly realized as a subset of healthcare informatics
8. Health informatics may mean informatics used in educating healthcare clients and/or the general public
9. As healthcare informatics evolves, so will the clarity in definition of terms and scopes of practice
10. Healthcare informatics addresses the study and management of healthcare information
11. A model of overlapping discrete circles could depict the integrated content most often considered
representative of the multiple and diverse aspects of healthcare informatics
12. Healthcare informatics would be the largest encompassing circle surrounding smaller intersecting circles
13. These aspects include specific content areas such as
 Information retrieval
 Ethics
 Security
 Decision support
 Patient care
 System life cycle
 Evaluation
 Human-computer interaction (HCI)
 Standards
 Telehealth
 Healthcare information systems
 Imaging
 Knowledge representation
 Electronic health records (EHRs)
 Education
 Information retrieval

Nursing Informatics
1. Nursing informatics (NI) is a subset of healthcare informatics
2. It shares common areas of science with other health professions
3. Easily supports
 Interprofessional
 Education
 Practice
 Research focused on healthcare informatics
4. Nursing informatics also has unique areas that address the special information needs for the nursing profession
5. Nurses work both
 Collaboratively with other healthcare professionals
 Independently when engaged in clinical and administrative nursing practice
6. Nursing informatics reflects this duality as well, moving in and out of integration and separation as situations
and needs demand
 7. In 1985, Kathryn Hannah proposed a definition that nursing informatics is the use of information technologies in
relation to any nursing functions and actions of nurses (Hannah, 1985)
8. Graves and Corcoran (1989) presented a more complex definition of nursing informatics. Nursing informatics is a
combination of computer science, information science, and nursing science designed 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
9. The ANA modified the Graves and Corcoran (1989) definition with the development of the first scope of practice
statement for nursing informatics
 The ANA (1994) defined nursing informatics as 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
10. The explanation of the accompanying standards of practice for nursing informatics followed in 1995 with ANA’s
publication of the Standards of Nursing Informatics Practice
11. In 2000, the ANA convened an expert panel to review and revise the scope and standards of nursing informatics
practice
 That group’s work included an extensive examination of the evolving healthcare and nursing
environments and culminated in the publication of the Scope and Standards of Nursing Informatics
Practice (2001b)
12. This professional document includes an expanded definition of nursing informatics that was slightly revised in
the 2008 Nursing Informatics: Scope and Standards of Practice to include wisdom
 Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information
science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI
supports consumers, patients, nurses, and other providers in their decision making in all roles and
settings
 Further into the revised document, a slightly amended definition is provided: Nursing informatics (NI) is
a specialty that integrates nursing science, computer science, and information science to manage and
communicate data, information, knowledge, and wisdom in nursing practice. NI facilitates the
integration of data, information, knowledge, and wisdom to support patients, nurses, and other
providers in their decision making in all roles and settings. This support is accomplished through the use
of information structures, information processes, and information technology
13. The Nursing Informatics Special Interest Group of the International Medical Informatics Association (IMIA-NI)
adopted the following definition in 2009
 Nursing informatics science and practice integrates nursing, its information and knowledge and their
management with information and communication technologies to promote the health of people,
families, and communities world wide
 Then in 2014, ANA’s second edition of Nursing Informatics: Scope and Standards of Practices presented
an updated definition: Nursing informatics (NI) is a specialty that integrates nursing science with
multiple information management and analytical sciences to identify, define, manage, and communicate
data, information, knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses,
and other healthcare professionals 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
14. These multiple definitions illustrate the dynamic, developing nature of this still-young nursing specialty
15. Development of different definitions and a healthy debate of those definitions promotes validation of key
elements and concepts
16. A willingness to continue exploring possible definitions can prevent premature conceptual closure, which may
lead to errors in synthesis and knowledge development

Nursing Informatics as a Specialty

1. Characteristics of a nursing specialty include
 Differentiated practice
 A well-derived knowledge base
  A defined research program
 Organizational representation
 Educational programs
 Credentialing mechanism
2. In 1992, the ANA recognized nursing informatics as a specialty in nursing with a distinct body of knowledge
 Unique among the healthcare professions
 This designation as a specialty provides official recognition that nursing informatics is indeed a part of
nursing and that it has a distinct scope of practice
3. The core phenomena of nursing are the
 Nurse
 Person
 Health
 Environment
4. Nursing informatics focuses on the information of nursing needed to address these core phenomena
5. Within this focus are the meta-structures or overarching concepts of nursing informatics:
 Data
 Information
 Knowledge
 Wisdom
6. It is this special focus on the information of nursing that differentiates nursing informatics from other nursing
specialties
7. Research programs in NI are guided by the research priorities set by National Institute for Nursing Research
(NINR)
 These priorities were first identified in 1993
 The priorities include:
o Using data, information, and knowledge to deliver and manage care
o Defining and describing data and information for patient care
o Acquiring and delivering knowledge from and for patient care
o Investigating new technologies to create tools for patient care
o Applying patient care ergonomics to the patient-nurse machine interaction
o Integrating systems for better patient care
o Evaluating the effects of nursing informatics solutions
8. Nursing informatics is represented in international, national, regional, and local organizations
9. Increasingly, nursing school curricula include content, and sometimes complete courses, on information
technologies in healthcare and nursing
 In 1989, the University of Maryland established the first graduate program in nursing informatics
 The University of Utah followed in 1990
 Now there are several in-person and online programs for graduate work in this specialty
 Doctoral programs in nursing informatics have been established
10. The American Nurses Credentialing Center (ANCC) established a certification process and examination in 1995 to
recognize those nurses with basic informatics specialty competencies
11. The American Nurses Credentialing Center (ANCC) has used scholarship on nursing-informatics competencies
and its own role-delineation studies to develop and maintain the nursing informatics certification examination
12. The ANCC-designated NI content-expert panel has oversight responsibility for the content of this examination
and considers the current informatics environment and research when defining the test-content outline
13. The test-content outline is available for free on the ANCC website
14. The Healthcare Information and Management Systems Society (HIMSS) established a certification program,
known as the certified professional in healthcare information and management systems (CPHIMS), which may
be of interest to informatics nurses
15. Two other informatics-related certification programs are offered by the American Health Information
Management Association (AHIMA)
 The first certification is as a registered health information administrator (RHIA)
 o RHIA manages patient health information and medical records, administers computer
information systems, collects and analyzes patient data, and uses various classification systems
and medical terminologies
o The second AHIMA certification is as a registered health information technician (RHIT)
o In this specialty, professionals ensure the completeness and accuracy of patient data entered
into computer systems and focus on coding of diagnoses and patient procedures

Models for nursing Informatics

1. The foundations of nursing informatics are the core phenomena and nursing-informatics models
2. The core phenomena are data, information, knowledge, and wisdom and the transformations that each of these
undergo
3. Models are representations of some aspect of the real world
4. Models show particular perspectives of a selected aspect and may illustrate relationships
5. Models evolve as knowledge about the selected aspect changes and are dependent on the “worldview” of those
developing the model
6. It is important to remember that different models reflect different viewpoints and are not necessarily
competitive, that is, there is no one “right” model
7. Different scholars in nursing informatics have proposed different models
8. Some of these models are presented here to provide further perspectives on nursing informatics, to
demonstrate how differently scholars and practitioners may view what seems to be the same thing, and to show
that nursing informatics is an evolutionary, theoretical, and practical science
9. Graves and Corcoran’s (1989) seminal work included a model of nursing informatics
 Their model placed data, information, and knowledge in sequential boxes with one-way arrows pointing
from data to information to knowledge
 The management processing box is directly above, with arrows pointing in one direction from
management processing to each of the three boxes
 The model is a direct depiction of their definition of nursing informatics
10. In 1986, Patricia Schwirian proposed a model of nursing informatics intended to stimulate and guide systematic
research in this discipline
 Her concern was over the sparse volume of research literature in nursing informatics
 The model provides a framework for identifying significant information needs, which in turn can foster
research
 In this model, there are four primary elements arranged in a pyramid with a triangular base
 The four elements are the
o Raw material (nursing-related information)
o Technology (a computing system comprised of hardware and software)
o Users surrounded by context (nurses, students)
o Goal (or objective) toward which the preceding elements are directed
 e. Bidirectional arrows connect the three base components of raw material, user, and computer system
to form the pyramid’s triangular base
 f. The goal element is placed at the apex of the pyramid to show its importance
 g. All interactions between the three base elements and the goal are represented by bidirectional
arrows
11. Turley, writing in 1996, proposed another model
 In which the core components of informatics (cognitive science, information science, and computer
science) are depicted as intersecting circles
 Nursing science is a larger circle that completely encompasses the intersecting circles
 Nursing informatics is the intersection between the discipline-specific science (nursing) and the area of
informatics
12. McGonigle and Mastrian developed the foundation of knowledge model
 The base of this model shows data and information distributed randomly
 From this base, transparent cones grow upward and intersect
 The upward cones represent acquisition, generation, and dissemination of knowledge
 Knowledge processing is represented by the intersections of these three cones
 Circling and connecting all of the cones is feedback
 The cones and feedback circle are dynamic in nature