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Nursing, Information and Computer Science: Building Blocks of Nursing Informatics. Mary Regan, RN, PhDUniversity of Marylands School of Nursing

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1What is Nursing Informatics?The use of information and technology to communicate, manage knowledge, mitigate error and support decision making (QSEN, XXX)The science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide. (IMIA Special Interest Group on Nursing Informatics, 2009)InformaticsNursing Informatics#

What is informatics?IMIA - International Medical Informatics AssociationThe science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide. (IMIA Special Interest Group on Nursing Informatics, 2009)

QSEN defines Nursing Informatics as the "science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide." (IMIA Special Interest Group on Nursing Informatics 2009).

It the integration of nursing, computer and information science devoted to managing, communicating data, information and knowledge about and for nursing practice.

Traditionally, undergraduate nursing education rarely teaches students how to use information and technology to communicate, manage knowledge, mitigate error and support decision making (QSEN definition of Informatics) although expertise in these skill is the foundation of safe practice

Not only do few nursing curricula do not include content specific to NIBut faculty also lack knowledge about HITs and its application necessary to develop NI competencies in their students

This is a significant gap in nursing education because information and how we access and use it is pivotal to nursing practice and necessary to ensure safe practice and optimal health outcomes

2The Knowledge behind Nursing InformaticsNursing ScienceInformation ScienceComputer Science#

Nursing ScienceThe study of phenomenon at the core of the discipline the knowledge unique to nursing and nurses

Information Science The study of how data is processed, managed and retrieved

Computer ScienceThe study of computation and the design of computers- subfields of the science are practical techniques design, development, implementation and application and the theories guiding those activities

3Because

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Because nurses are knowledge workers. The work they do demand a high level of applied knowledge. By necessity they have to think for a living. The are constantly engaging in non-routine problem solving that requires them to think critically and creatively to find solutions to the clinical problems they face on a daily basis. 4What is a knowledge worker?

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Sheridan, W.P. How to Think like a Knowledge Worker: A guide to the mindset needed to perform competent knowledge work. United Nations Public Administration Network, New York. [Internet] Available from: http://unpan1.un.org/intradoc/groups/public/documents/unpan/unpan031277.pdf [Accessed 24 August 2008]Read more: Thinking like a Knowledge Worker | E-Learning Curve Blog Under Creative Commons License: Attribution Non-Commercial No Derivatives

This represents the cognitive processes necessary to perform competent knowledge work5Nurses as Knowledge Workers

Phenomenology#

Sheridan, W.P. How to Think like a Knowledge Worker:A guide to the mindset needed to perform competent knowledge work. United Nations Public Administration Network, New York. [Internet] Available from: http://unpan1.un.org/intradoc/groups/public/documents/unpan/unpan031277.pdf [Accessed 24 August 2008]Read more: Thinking like a Knowledge Worker | E-Learning Curve Blog Under Creative Commons License: Attribution Non-Commercial No Derivatives

(Image from http://t2.gstatic.com/images?q=tbn:ANd9GcROhSc324SQBR6-2CUyogquqDmfGUmCORdVFQqgYqLQZlizQPC2)

Sheridan argues that to be a knowledge worker individuals need to understand themselves and challenge their habits of mind. The thinking process of a knowledge worker included:Phenomenology: relates to the patterns of perception that shape how we experience the worldPresences or absence our temporal or spatial proximity to phenomenaPart versus the whole: focus on the parts or the whole Unity versus diversity: how we experience reality interdependent or autonomous

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MoralityPhenomenology#

Morality: how evaluate experience on the basis of external controls or internal deliberations1. Commands vs. Conscience: do we choose to follow orders the observed way of doing or do we follow our consciousness and advocate for difference2 2. Inclusion vs. Exclusion: what discourses or ideologies from what groups do we choose to include or exclude - The parameter that underlies inclusion and exclusion is association.3. Injunctions vs. Prohibitions: Doing what you are told to do (injunctions) and doing what you are told NOT to do.

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PlausibilityMoralityPhenomenology#

Plausibility: concerns the premises and preseumptions that we habitually use to examine reality (ie microscopic or macroscopic, case-by-case or aggregated)Theory vs. Practice: Focused on the forest of the trees - practice that is a tangible behavior or endorsing theory that is an intangible and implicit schema.Differentiate vs. Correlate: Particular instances of a phenomenon or the average of a series - comparison or contrast3. Exact vs. Fuzzy: definite outlines (i.e., sticks, stones, men, mice, etc.), or indefinite outlines (i.e., water, air, entropy, gravity, etc.). Definite outlines can be quantified precisely where indefinite outlines can only be measured, approximately.

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PlausibilityMoralityPhenomenologyPreferentiality#

Preferentiality: Personal style or taste - how we appreciate experience Style vs. Statement: the desire to state an ideology by example. Expression vs. Impression: Creating a culture by self expression or following others that impress us. Attraction vs. Aversion: Things we find attractive being repelled by those things we are adverse toward.

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PlausibilityMoralityPhenomenologyPreferentialityCognitivityAffectivityKNOWING#

KNOWING is a combination of what we think (and all those things that influence it) and what we feel

Thinking involves the separation of relevant information from irrelevant information.think work is a component of knowledge work, specifically the information processing part the other part is just the informed action part.

Knowledge is characterized by observable facts, thinking through what they mean and then conceptualizing a new reality based on that constructed reality. The problem is that we often focus on one of these activities but rarely address all three. Health information systems provide an efficient mechanism to help nursing manage the information flow that is at the integral to their work. The problem with not including informatics into nurses education is that when they enter the workforces they cannot utilize HIT to help them manage information more efficiently. In addition, as soon at they get there they have to master the multiple technologies in the practice setting and then on top of that they have to continually adapt to continued advances in IT, evolving sophistication of information management as well as requirements for evidenced based practice. By integrating NI content throughout the curriculum they can develop basic competence and the necessary technical skills and knowledge to engage in leveraging these powerful tools to streamline and optimize their knowledge about practice so that they can function more efficiently as a knowledge worker. This has the added benefit of improving the HIT themselves because It is only when nurses engage fully in the process of evaluating, selecting and implementing HITs used at the bedside that the design of those systems will begin to conform to meet the requirements of nursing workflow

10So why do we need to integrate informatics?

PlausibilityMoralityPhenomenologyPreferentialityCognitivityAffectivityKNOWING#

Because in todays complex and chaotic environments where patient acuity is high and lengths of stay of shortnurses have to know more and do their work in an expedited time frame and to do that efficiently in a way minimizes the risk of error they have to use computerized information systems

Caring for patients generates a massive quantity of data all of which needs to be efficiently and correctly entered, transmitted, managed, secured and mined.The technologies commonly found in the health care system include information and communications technologies used to collect data, use of information and generate knowledge to support nursing practice

Continued advances in IT, evolving sophistication of information management and requirement for evidenced based practices means that nurses at all level need to develop the necessary technical skills and knowledge to engage in not only using the technologies, but more importantly evaluating, selecting and implementing them into the nursing workflow11Nursing Informatics: The Practice The essence of scienceGathering dataAnalyzing the dataInterpreting the findingsApplying the conclusions #

The basis of nursing informatics is similar to the scientific process

We collect data discrete bits and bytes of data that on their own have no meaning

We analyze it to identify patterns and understand how it is organized and combined

We interpret the findings to uncover the relationships that exist and how they are in associated with particular outcomes

That knowledge shapes future practices

12DIKW ModelDataInformationKnowledgeWisdom#

Ackoff, R. L., "From Data to Wisdom", Journal of Applies Systems Analysis, Volume 16, 1989 p 3-9.

Data represents a fact or statement of event without relation to other things.Ex: 70

Information indicates a relationship of some sort or even cause and effect.120/70 or 135/80 when the legs are crossed

Knowledge connects data into an identifiable pattern that provides clarity about what is happening and will happen next.The blood pressure reading can be elevated if the persons legs are crossed when the reading is taken

Wisdom is understanding of the fundamental principles a much higher level. Blood pressure is the measure of the The blood pressure is the pressure of the blood in the arteries. The systolic is the pressure of the heart contracting and the diastolic is the pressure when the hear is relaxed between beats. Definitions of normal, physiological factors that influence blood pressure etc. 13The Scientific Process

Image from http://www.inmagine.com/spl015/spl015616-photo

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AUDIENCE ACTIVITYLets look at how that works in practice:

What is happening in the picture? http://www.inmagine.com/spl015/spl015616-photo

What data is available?How should the data be analyzed or combined?How do you Interpret the findings what does it mean?How does that influence the future practice?

14DIKW ModelData

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AUDIENCE ACTIVITYDataWhats the objective data expressed in the photo?Middle aged manDropping on left side of the faceBody slumped to the left

Ackoff, R. L., "From Data to Wisdom", Journal of Applies Systems Analysis, Volume 16, 1989 p 3-9.

15DIKW ModelDataInformation

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Information relational connections between the data pointsWhat happens when we combine the data? Who is this person?A middle aged manWhat is happening:Hes had a right sided stroke (reference Jill Bolte - wja Where is he?Hes sitting outsideWhen did he have the stroke?

A series of blood measures is information

16DIKW ModelDataInformationKnowledge

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Knowledge recognizing and understanding patterns and what they meanHow did this happen?Hes well groomed, looks professionalHes in his late 50s or 60s So he probably a professional in a high stress job, Hes slim but his job is unlikely to be overly physical so she he doesnt get a lot of exerciseAt risk for hypertension and strokeMay be on asprinHes had a right side stroke -

Now we know what to doKnowledge is context based interpretation of the signs that reflects a synthesis of the information17DIKW ModelDataInformationKnowledgeWisdom

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WisdomEvaluating what we know and how its relevant

18DIKW ModelDataInformationKnowledgeWisdomComplexityUnderstanding#

SummaryThe more data we gather, the more connections we can make and the more we understand

Ackoff, R. L., "From Data to Wisdom", Journal of Applies Systems Analysis, Volume 16, 1989 p 3-9.

19Nursing informatics competenciesComputer knowledgeInformatics skillsInformatics knowledgeInformatics competenciesHuman information processing skillsInformation management competenciesFrom Staggers, N., Gassert, C., & Curran, C. (2002). A Delphi study todetermine informatics competencies for nurses at four levels of practice. Nursing Research, 51 (6) 383390.#

To date there are no universally required informatics competencies for nurses graduating at any level. By this I mean core competencies for:

1. Entry level nurses students and new graduates; Beginner2. Practicing RNs intermediate3. Nursing Informaticists : advanced4. Innovator

At each level nurses need to be systematically educated to equip them with the requisite knowledge to:enter, retrieve and manipulate data from information and communication systems Transform data into information to shape their nursing practices, combine information to build their nursing knowledge, andShare that knowledge in whatever capacity is available to them to contribute to evolving nursing knowledge and wisdom

Informatics competencies along with human information processing skills comprise the overall construct of information management competencies.Three components of informatics competencies * Computer skillsinformatics knowledge informatics skills

are interdependent and of equal importance.

20NI competencies for Beginning Nurse Computer Skills Administration Communication Data access Documentation Education Monitoring Basic Desktop Software Systems

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Beginning nurses have fundamental information management and computer technology skills and use existing information systems and available information to manage their practice21NI competencies for Beginning Nurse Informatics Knowledge Data Impact Privacy/security Systems

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22Integrating Informatics Competencies into Nursing EducationEssential I: Liberal Education for Baccalaureate Generalist Nursing PracticeA solid base in liberal education provides the cornerstone for the practice and education of nurses.

Integrate theories and concepts from liberal education into nursing practice. Synthesize theories and concepts from liberal education to build an understanding of the human experience.Use skills of inquiry, analysis, and information literacy to address practice issues.Use written, verbal, nonverbal, and emerging technology methods to communicate effectively.Apply knowledge of social and cultural factors to the care of diverse populations.Engage in ethical reasoning and actions to provide leadership in promoting advocacy, collaboration, and social justice as a socially responsible citizen.Integrate the knowledge and methods of a variety of disciplines to inform decision making.Demonstrate tolerance for the ambiguity and unpredictability of the world and its effect on the healthcare system.Value the ideal of lifelong learning to support excellence in nursing practice.#

Sample Content selected concepts and ways of knowing from the sciences selected concepts and ways of knowing from the arts principles related to working with peoples from diverse cultures concepts related to intellectual diversity, tolerance, and social justice concepts related to globalization and migration of populations23Integrating Informatics Competencies into Nursing EducationIntegrate theories and concepts from liberal education into nursing practice. Synthesize theories and concepts from liberal education to build an understanding of the human experience.Use skills of inquiry, analysis, and information literacy to address practice issues.Use written, verbal, nonverbal, and emerging technology methods to communicate effectively.Apply knowledge of social and cultural factors to the care of diverse populations.Engage in ethical reasoning and actions to provide leadership in promoting advocacy, collaboration, and social justice as a socially responsible citizen.Integrate the knowledge and methods of a variety of disciplines to inform decision making.Demonstrate tolerance for the ambiguity and unpredictability of the world and its effect on the healthcare system.Value the ideal of lifelong learning to support excellence in nursing practice.Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice

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24Putting the competencies into the curriculumReview the essential assigned to your table and identify the criteria that address informatics

Use the matrix to identify which of the competencies fit with the criteria from the essential

Review the course outlines, objectives and assignments in the syllabi brought by members of the group.

Identify strategies that could be used to teach the content in ways that build NI competencies among the students.

Document your ideas on the paper provided to share with the group as a whole

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25Questions?Thank you for participating in this session. If you have outstanding questions please feel free to contact Maryregan@son.umaryland.edu410-706-1175#

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