NURSING INFORMATIC 2

NURSING INFORMATIC 2

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients. 

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved. 

                                                  To Prepare:   

Review the Resources and reflect on the evolution of      nursing informatics from a science to a nursing specialty. 

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization 

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

                                   Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

· Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

· Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf 

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf 

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05. 

Note: You will access this article from the Walden Library databases.

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019. 

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Public Health Informatics Institute. (2017). Public Health Informatics: “shipping” information for better health [Video file]. Retrieved from https://www.youtube.com/watch?v=q1gNQ9dm0zg.

Public Health Informatics Institute. (2017). Public Health Informatics: knowledge “architecture” [Video file]. Retrieved from https://www.youtube.com/watch?v=sofmUeQkMLU.

NURS 6051 Week 3 Media: Data, Information, Knowledge, and Wisdom Continuum

Information technology is transforming the health care field with a plethora of new tools, software, and devices. This transformation has especially affected nurses, which is why health care information technology is often referred to as “nursing informatics.”

Nursing informatics is used in practice settings to help organize and apply data, information, knowledge, and wisdom. The continuum of data, information, knowledge, and wisdom shows how nurses use facts to make decisions and provide care. This continuum provides insight for how nursing informatics contribute to different levels of understanding, decision-making, and evidence-based practice.

The lowest level on the continuum is data. The term “data” refers to discrete sets of details related to a specific situation, patient, or population. You can think of data as isolated islands of facts that any observer would be able to view and objectively identify.

The next level on the continuum, directly above data, is information. Information is the result of processing and organizing data into more manageable structures, and interpreting the meanings of individual data points. Information systems, such as electronic health records (EHRs), compile data and support nurses at the information level of the continuum.

After information, the next level up is knowledge. Knowledge arises when information is synthesized into formal relationships and interconnections. Knowledge involves recognizing patterns and abnormalities based on separate sets of information. Nursing informatics that operate at the knowledge level are called decision-support systems.

Finally, the highest level of the continuum is wisdom. Wisdom is the application of knowledge to addressing clinical problems and complex patient health issues with compassion and regard for ethics and quality of life.

Let’s explore a clinical example of how data, information, knowledge, and wisdom build on each other. Consider a 48-year-old male patient of average height who is slightly overweight. The patient’s recent blood test indicates that he has impaired glucose tolerance and slightly high cholesterol. All of these initial facts about the patient represent data.

The nurse discusses the results of the blood test with the patient, and invites him to return for a follow-up visit. The second blood test indicates higher glucose levels and the same high cholesterol. These serialized blood test results represent information.

The nurse then takes this information, refers to the patient’s electronic health record, and discovers that the patient has a family history of diabetes. This data, added to the information from the blood tests, allows the nurse to determine that the patient has type 2 diabetes. This diagnosis is knowledge.

Finally, the nurse uses wisdom to determine the most appropriate strategy for addressing this patient’s diabetes. Because the patient does not have a personal history with diabetes and is relatively young, the nurse discusses lifestyle interventions to manage his glucose levels. If after six months, the patient’s glucose is not within the normal range, the nurse and the physician will consider medications and other treatment options.

This example illustrates the flow from data to information, information to knowledge, and knowledge to wisdom. It also demonstrates how nurses apply this continuum in their everyday practices and how informatics can play an important role.

AmericanNurseToday.com November 2017 American Nurse Today 45

• Data and care quality go hand in hand.

NURSES, as the largest group of healthcare profes- sionals, are key to quality and safety and to ensuring the best patient outcomes. To make informed practice decisions, nurses need access to aggregate data about their patients and the impact of their care, and they need to know how to interpret that data. This article explores

the role data plays in quality and safety and the synergistic relationship between data and nursing practice.

What’s the connection between data and quality and safety? In 2002, the Institute of Medicine held the Health Professions Education Summit to discuss poten- tial reforms, with the goal of improving quality and pa- tient safety. The summit, which included participants from throughout the healthcare disciplines, defined and developed core competencies in patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics that should be included in all health profession education. Nursing led the charge in this effort with the devel-

opment of the Quality and Safety Education for Nurs- es (QSEN) Institute, which has defined the essential knowledge, skills, and attitudes that ensure all new RNs and advanced practice RNs (APRNs) are prepared to participate in healthcare teams to improve quality and patient safety. QSEN has developed core compe- tencies that reflect the outcomes of the 2002 summit: • patient-centered care • teamwork and collaboration • evidence-based practice • quality improvement • safety • informatics. Both the summit and the QSEN included informatics

as a competency needed to ensure quality and safety.

Informatics The informatics competency helps nurses use informa- tion and technology to communicate, manage knowl- edge, mitigate error, and support decision-making at the point of care. Because of the rapid changes in healthcare information and technology, nursing stu- dents must know why information and technology skills are essential for safe patient care, understand how to apply information and technology tools, and appreciate the need for lifelong learning on these top-

ics. (See Informatics re- quirements.)

How do we leverage the electronic health record? The Health Information Technology for Econom- ic and Clinical Health (HITECH) Act promotes the adoption and mean- ingful use of health infor- mation technology. (See What is meaningful use?)

The goal of HITECH and the original meaningful use legislation is to share electronic health record (EHR) data with patients and engage them in their care. Many hospitals and health systems with mature EHRs have portals for patients to access and record their own health data. Sharing this data, within the parameters of the Health Insurance Portability and Accountability Act, supports the meaningful use of EHRs. Nurses can help encourage public adoption of EHRs by supporting the meaningful use of electroni- cally generated health data.

How do nursing practice and data inform each other? Nurses, who do most of the EHR documentation (in- cluding plans of care, physiological parameters, assess- ments, interventions, and progress evaluations) in hos- pitals, are critical to care integration and patient safety. Whether entered into flow sheets or as “smart phrases” or narratives, all data are important to the healthcare team’s understanding of the individual patient. Be- cause nurses regularly review individual patient data, they’re the essential communicators to providers about

Using data in nursing practice By Kimberly S. Glassman, PhD, RN, NEA-BC, FAAN

Practice Matters

46 American Nurse Today Volume 12, Number 11 AmericanNurseToday.com

any overt or subtle changes in a patient’s condition. EHRs also help nurses understand how to care for

populations of patients. To do that, information about individual patients must be extracted and compiled into flow sheet rows. Vital signs and other physio – logic measurements lend themselves nicely to flow sheet input. However, the context of the individual patient’s story—the narrative that explains why he or she sought health care and what may have led to the problem—doesn’t fit neatly into a flow sheet and

fragments the story. Nurses must partner with the vendors of EHR systems to improve this workflow so that the important narrative in- formation can be captured to im- prove health for all patients. In ambulatory care, much of the

documentation required for quality metrics (such as screening tests, to- bacco use, vaccines, and health teaching) is done by nursing staff. Some of these data are collected using a simple checkbox in the record. However, by checking yes or no about smoking, the patient can’t give any context for why he or she uses tobacco, information about multiple quitting attempts, or the as- pects of his or her life that support

or thwart the desire to quit. The opportunity for nurses to inform their documentation is essential for capturing relevant detailed patient information. And rather than serving as the recorder of the patient’s information, nurses can support simple methods for patients to cap- ture their own stories. The quality of our nursing care and documentation

informs the public and insurance companies through publicly reported measures at sites such as medicare.gov/ hospitalcompare/search.html. As the most trusted professionals, we can leverage our relationship with patients to support better engagement with EHRs to capture the important data that allows us to provide better care. Nurses have to keep the patient front and center in everything we do and our ability to advo- cate for patients can include educating and support- ing them to enter their own data into secure patient portals.

What’s the future of data and technology? Eliminating duplication of effort will go a long way to simplifying and streamlining nursing workflow within EHRs. Patient care devices (such as cardiac monitors, vital sign monitors, and I.V. infusion pumps) can be linked with the EHR. Many of them are essentially mi- ni-computers that store and send their discrete data to the EHR. Currently, a significant amount of complexity is involved with these data transfers. In the future, we’ll expect them to be seamless and done in real time. Here are some examples of current and future tech- nologies that improve our ability to obtain and analyze patient data. Radio-frequency identification (RFID) tags are used to-

day to locate mobile equipment and people. Some RFIDs can tell members of the team where to find the practi- tioner, nurse, or assistive personnel. All of the data can

The Quality and Safety Education for Nurses informatics competency requires that nursing students:

• understand the database of health information about patients (typically the electronic health record [EHR])

• demonstrate how to navigate the EHR • appreciate the importance of the nurse’s input into the record • value the ability of technology to support clinical decision-making, support

safe care, and reduce errors.

At the graduate level, the informatics competency requires:

• in-depth knowledge of informatics principles • an understanding of the strengths and weaknesses of various technology systems • the ability to evaluate the use of technology systems in supporting patient care • the skill to describe and critique the taxonomy systems (nursing language) that

support interoperability of EHR information to improve the nation’s health.

Informatics requirements

Meaningful use of certified electronic health record tech- nology:

• improves quality, safety, and efficiency, and reduces health disparities

• engages patients and their families • improves care coordination and population and public

health

• maintains privacy and security of patient health infor- mation.

For hospitals to qualify for Centers for Medicare & Medicaid Services Electronic Health Records Incentive Programs, meaningful use must meet specific objectives, which fall into three stages:

1 Capture and share data with patients and other providers, as permitted by the patient.

2 Advance clinical processes. 3 Improve outcomes.

Ultimately, meaningful use compliance results in improved clinical and population health outcomes, increased trans- parency and efficiency, empowered individuals, and robust research data on health systems.

What is meaningful use?

AmericanNurseToday.com November 2017 American Nurse Today 47

be downloaded to a searchable and retrievable database. Middleware is software that links a patient’s monitor-

ing device to a nurse’s personal device. Some hospitals provide their staff with smartphones for communication between patients and nurses (nurse call), among team members (secure texting and direct calls), and between medical devices and nurses (alarm conditions with im- ages and values). Wearable medical devices, similar to fitness devices

that track steps and heart rate, will make technology that we use now obsolete. For instance, the current telemetry box will shrink to a wearable device that monitors not only cardiac function, but laboratory val- ues as well. All of these devices and applications will evolve as

technology improves.

What can you do? To help make the future of nursing data a reality and provide nurses with more quality time with their pa- tients, you must get involved. Be part of the selection process for new technology, provide feedback about technology support to improve workflows, and com- municate with technology companies about what will improve patient care. Without your input, nurses are at the mercy of what engineers think is best.

Kimberly S. Glassman is senior vice president of patient care services and chief nursing officer at the New York University Langone Medical Center.

Selected references Blumenthal D, Tavenner M. The “meaningful use” regulation for elec- tronic health records. N Engl J Med. 2010;363(6):501-4.

Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and safety education for nurses. Nurs Outlook. 2007;55(3):122-31.

Cronenwett L, Sherwood G, Pohl J, et al. Quality and safety educa- tion for advanced nursing practice. Nurs Outlook. 2009;57(6):338-48.

Greiner AC, Knebel E, eds; Institute of Medicine Committee on the Health Professions Education Summit. Health Professions Education: A Bridge to Quality. Institute of Medicine. Washington DC: National Academies Press; 2003.

HealthIT.gov. EHR incentives & certification: Meaningful use defini- tion & objectives. healthit.gov/providers-professionals/meaningful- use-definition-objectives

HIMSS®. Explore the HIMSS analytics stage 7 hospitals. June 15, 2015. http://www.himss.org/explore-himss-analytics-stage-7-hospitals

Institute of Medicine. The Future of Nursing: Leading Change, Ad- vancing Health. Washington DC: National Academies Press; 2010.

Medicare.gov. Hospital compare: Survey of patients’ experiences (HCAHPS) star ratings. medicare.gov/hospitalcompare/Data/HCAHPS- Star-Ratings.html

Topol E. The Creative Destruction of Medicine: How the Digital Revolu- tion Will Create Better Health Care. New York, NY; Basic Books: 2012.

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