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Nursing Informatics: Past, Present and Future By A. Ruth Chastain, EdD, RN Nursing informatics has impacted the practice of nursing for the past three decades. It has served as an effective tool for helping the nurse manage information more effectively. New information is generated at a phenomenal pace in the healthcare arena at the present time. Since both new graduates and current professional nurses practice in this evolving environment, accessing current information will be essential for maintaining competence in the future. Nursing Informatics: The Past Nursing informatics was defined in the literature by Ball and Hannah as early as 1984 as the discipline of applying computer science to nursing processes. This was a beginning awareness of the opportunities for effective use of computerization in nursing. At that time computers were used in hospitals for patient registry, communicating with various departments of the hospital to implement physicians’ orders, reporting results of laboratory and radiology tests and patient monitoring. Interest grew in nursing informatics as technology expanded. In 1987, Cox, Harsanyi and Dean concluded that healthcare dilemmas could more easily be explored through computer technology. These authors liken societal fears and behaviors toward computer technology to the behaviors that were evident at the time of the Industrial Revolution. The Southern Regional Education Board (SREB) sponsored the Second Regional Conference entitled Shaping Directions for Computer Use in Nursing Education in March 1988. At this conference, nursing leaders presented the need for and strategies to include computer technology in nursing education. Grobe (1988) listed informatics competencies for practicing nurses. “These include: 1. documenting nursing practice, 2. assessing information, 3. using data and information of a system, and 4. coordinating information flow” (p.5). Grobe also recommended three levels of competency, from simple everyday use of computers to complex and innovative program development. These early definitions were the foundation for the American Nurses Association (ANA) to define nursing informatics in 1994 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” (ANA, 1994, p.3). Nursing Informatics: The Present ANA recognized nursing informatics (NI) as a nursing specialty by delineating the Scope of Practice (1994), Standards of Practice (1995), organizing a Council within ANA (1997) and providing credentialing in nursing informatics (American Nurses Credentialing Center, 1997). In 1997, Wedde observed that student nurses and practicing nursing professionals must stay abreast of technological advances to provide competent patient care, education and research. In the 2001 edition of the Scope and Standards of Nursing Informatics Practice, the ANA stated that “data, information, and knowledge are the metastructures in NI” (p.5). The standards further described the relationship of these metastructures in NI. “As data are transformed into information and information into knowledge, each level increases in complexity and requires greater application of human intellect” (p.6). Technology is a tool for nurses to use to bring data to the knowledge level and useful for nursing practice to manage and improve communication. When addressing informatics competencies, the ANA (2001) stated that the beginning nurse “is expected to have fundamental information management and computer literacy skills” (p.25). Expected competencies of experienced nurses include “use current informatics solutions, but also collaborate with the informatics nurse specialist to suggest improvements to these informatics solutions” (p.26). Nurses are responsible for evaluating health information which consumers access using technology. In many healthcare settings nurses are expected to use Integrated Delivery Systems (IDS) as more facilities “go paperless.” The Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 2002) identified “emerging clinical information systems and other technologies that can improve safety, reduce paperwork and provide nurses with more time to spend on care-giving” (p.21) as a mechanism to prevent nursing errors. Thus, JCAHO recommended that hospitals, “Adopt information, ergonomic and other technologies designed to improve work-flow and reduce risks of error and injury” (p.21). These competencies and recommendations are overwhelming to many nurses. However, to meet the expectations, nurses may participate in Web based academic course work, Web based continuing education courses, subscribe to eBulletins or listservs that are general in focus or specific to practice areas, or view the most recent nursing publications online. The well-established nursing organizations, such as the Tennessee Nurses Association (TNA), have formed an Informatics Council to help members understand this nursing area. There are also nursing specialty organizations such as Capital Area Roundtable on Informatics in NursinG (CARING). The mission of this organization is, “CARING is an organization advancing the delivery of quality healthcare through the integration of informatics in practice, education, administration, and research with a focus on nursing” (available on-line at http://www.caringonline.org/members). Conferences such as the Weekend Immersion in Nursing Informatics (WINI) are available (Newbold, S. K., Bicksord, C.J., & Smith, M.K., 2002). The WINI conference “focuses on trends and issues in practice facing the profession and provides an examination of nursing informatics theories, impact of human factors, systems analysis and design approaches…” (available on-line at http://nursing.umaryland.edu/~snewbold/wini.htm, p.2). Participants find this conference helpful, as they review materials for informatics certification, and networking opportunities are available. There will be a WINI conference available in Nashville, Tennessee during September or October 2003. For further information about this conference, contact Dr. Betsy Weiner at [email protected]. Nursing informatics is also a specialty in the current healthcare arena. The Scope and Standards of Nursing Informatics Practice and competencies are clearly defined (ANA, 2001). Education for this specialty is offered on the master’s and doctoral levels. Certification is available through the American Nurses Credentialing Center (ANCC). Information for certification is available at www.nursecredentialing.org. Nursing Informatics: The Future The future of nursing informatics is difficult to predict. Data are being published at an astounding rate. The Information Quest (IQ) “indexes some 4,000 biomedical journals and adds over 9,000 article citations and abstracts from these journals to its database each week” (personal communication, 11/16/02 – Weekly eBulletin from Sigma Theta Tau International). The National Institutes of Health as well as private organizations such as the American Medical Informatics Association (AMIA) and Healthcare Information and Management Systems Society (HIMSS) are actively exploring the nurse’s role in research and solving problems in current and future health care needs. The Nursing Challenge The challenge for nurses is to use data to form information and move the information to knowledge, which will improve the healthcare of all peoples. This is especially critical during this period of nursing shortage. Nurses must accept opportunities to use current tools of technology as a basis for advancing the nursing profession. References American Nurses Association. (2001). Scope and standards of nursing informatics practice. Washington, DC: American Nurses Publishing. American Nurses Association. (1994). Scope of practice for nursing informatics. Washington, DC: American Nurses Publishing. American Nurses Credentialing Center. (1997). 1997 certification catalog. Washington, DC: American Nurses Publishing. Ball, M.J., & Hannah, K. J. (1984). Using computers in nursing. Reston, VA: Reston Publishers. Capital Area Roundtable on Informatics in NursinG (CARING). Accessed January 9, 2003 at http://www.caringonline.org/members/. Cox, H. C., Harsanyi, B., & Dean, L. C. (1987). Computers and nursing: Application to practice, education and research. Norwalk, CT: Appleton & Lange. Grobe, S. J. (1988). Computers’ use for professional practice: What nurses need to know. Shaping directions for computer use in nursing education, Second Regional Conference (pp.1-11). Atlanta: Southern Regional Education Board. Joint Commission on Accreditation of Healthcare Organizations. (2002). Health care at the crossroads: Strategies for addressing the evolving nursing crisis. Author. Newbold, S. K., Bickford, C.J., & Smith, M.K. WINI – Weekend immersion in nursing informatics. Accessed January 9, 2003 at http://nursing.umaryland.edu/~snewbold/wini.htm. Wedde, S. G. (1997). Outreach and continuing education: Technology revolutionized nursing education. Nursing Dimensions, 8, 18-20. A. Ruth Chastain, EdD, RN, is an associate professor at Union University. Her major responsibilities are in the master’s in nursing program. Her doctoral dissertation, “The Comparison of Nursing Graduates, Nursing Educators, and Employer Expectations for Information Technology,” revealed that employer expectations significantly exceeded the reported technology use and knowledge of both students and faculty. These findings challenged her to become more familiar with the use of technology in the practice of nursing. She teaches a graduate course in Information Systems in Healthcare and is currently serving as chair of the TNA Council on Nursing Informatics. For additional resources or to learn more about the TNA Council on Nursing Informatics, contact Dr. Ruth Chastain at Union University at [email protected]. To join the TNA listsev on nursing informatics, visit the TNA Web site at www.tnaonline.org.
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