Krishia Hidalgo

03/12/2014
Section II-4
Nursing Informatics in Taiwan
Nursing Informatics has really been a big part of the way Nurses deal with patients and
documentation. Many countries have adopted and embrace this change and one of them being
Taiwan. Not too long ago, Taiwan also joined the trend of using technology in the clinical field.
Many research and journal articles can prove that. There were 610 hospitals and 175,000
healthcare professionals in Taiwan 2002. Those healthcare professionals served a population of
22.5 million. The healthcare professional included 34.3% registered nurses and 17.7% licensed
practicing nurses.
The term Nursing Informatics was first used and introduced in Taiwan in 1990.
Computers had been used as an important tool in nursing education since the 1980s. It helped in
related nursing research into patient classification. National Science Council that began in the
1990s supported this. Although a formal master's program focusing on NI was not available until
2001, the elective courses in baccalaureate and masters programs have started in the late 1990s.
Although the demand for Nursing Informatics was increasing, some people werent to
fond of the change. The pattern for long term care information systems was similar, in that
almost 50% of long term care institutes were not planning any investment in information systems
and only 19% had installed information systems. One reason was because they didnt want to be
too dependent on computers for the nursing care of the patient and also because the computers
didnt come cheap they required an ample amount of money.
In 1986, The Ministry of Education for nursing vocational education programs developed
computer-assisted instruction programs. This made training the nurses more attainable. The
growth of the Internet has lead to the integration of distance education into nursing curricula.
Online courses are available for baccalaureate programs in counseling, teaching principles and
strategies, and long term care. This proved helpful for registered and licensed nurses to access
new information and education through the Internet.
Since Nursing Informatics only began in the 1990s, Nursing Informatics research is still
at its infancy in Taiwan. There were only around 40 papers published in domestic nursing
journals in the period 1994-2003. The first formal academic association on NI was set up in
2004. It was when a Nursing Informatics working group was organized within the Taiwan
Association of Medical Informatics. The Taiwan Association of Medical informatics had been
established in 1991. Standardized terminology such as existing nursing diagnosis classification
systems and the ICNP has been translated for clinical use. The tests of their reliability and
validity have been proposed in Taiwan.
Computerized care plans are now common in clinical use. They make documentation
more efficient and eliminate some possible documentation errors. Moreover, decision support
systems to test the integration of medical diagnoses and nursing diagnoses, and expert systems
implemented on PDAs for the emergency triage system have been reported. Decision support
helps the nurse to quickly make decisions while caring for the patients. It can help them
remember to assess a possible problem in a patient. Nurses in their daily practice have used PDA
recently in Taiwan.
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Section II-4
The ROC Biological and Medical Engineering Association and the Taiwan Association of
Medical Informatics successfully obtained approvals from the international DICOM and HL7
organizations to become the members in 2000. The ministry of Health to promote the
development of health informatics in Taiwan since 2002 has promoted a national e-Taiwan
program. This has helped the promotion of Nursing Informatics in Taiwan with not only the
practice but also the training of the healthcare team.
A journal article entitled, A Taiwan Model: Nursing Informatics Training showed a
glimpse of how nurses are being trained today with the use of technology and computers. Polun
Chang and Ming-Chuan Kuo wrote the journal article. They laid out the concept of End-User
Computing and they also discussed the learning model used in Taiwan since 2003. The new
learning model in Taiwan has improved the nurses competencies. End user computing refers to
systems in which non-programmers can create working applications. Examples of end-user
computing are systems built using fourth-generation programming languages, such
as MAPPER or SQL, or one of the fifth-generation programming languages, such as ICAD.
The authors explained how the model connects the nurses as it teaches them. The nurses
also get to interact and collaborate with IT professionals. This helps in the nurses taking on the
role of being a leader in designing the IT applications. The learning model has been used to train
more than 400 nurses and other members of the healthcare team. The model has taught them
important informatics concepts that they need to learn to use in the clinical area. The training of
those nurses included practical solutions for documentation and information management. The
program included communication tools for the nurses to contact the IT personnel incases they
needed help. One notable thing about the training model was that it had the creation of
innovative personal solutions.
The authors also provided information and guidance for six-day program or course. It consisted
of five stages, which were integrated in the learning system. They also emphasized the
importance of nursing informatics competencies in order to increase the amount of user input.
Nursing informatics competencies is also important for an enhanced performance of the nurse.
In another journal article entitled, Nursing Informatics Competencies Required of
Nurses in Taiwan: A Delphi Method the researchers conducted a study to evaluate the minimum
competencies required of Nurses in Taiwan. Jieh Chang conducted the study. A modified Webbased Delphi method was used to implement the study-seeking consensus with nursing
informatics competencies from two expert groups in nursing. The Delphi method is a structured
communication technique, originally developed as a systematic, interactive forecasting method,
which relies on a panel of experts.
The Nursing experts, including 23 nursing educators and 9 nursing administrators in
Taiwan, were recruited. The experts responded to the Nursing Informatics Competencies
Questionnaire. The Nursing Informatics Competencies Questionnaire had 323 items. The
researcher included 45 more items later on as the study progressed. Three Web-based Delphi
rounds were conducted to identify nursing informatics competencies required of nurses in
Taiwan. Analysis included detailed item analysis. It also had comparison of educators' and
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Section II-4
administrators' ratings using Fisher's exact test. Fisher's exact test is a statistical significance test
used in the analysis of contingency tables or the frequency distribution of multiple variables.
Competencies that met 60% or greater agreement of item importance and appropriate
level of nursing practice were included. By the conclusion of Round 3, 318 nursing informatics
competencies had achieved consensus of item importance. Appropriate level of nursing practice
was also accounted for in the consensus. There was a high degree of agreement regarding
specific nursing informatics competencies requirement for nurses in Taiwan. This study
established what nurses in Taiwan were expected to know in terms of Nursing Informatics. In
addition, the study updated the list of nursing informatics competency requirements, which has
international relevance since information technology is a global track in the nursing profession.
The article journal entitled, Using Change Theory to Examine the Nursing Informatics
Development in Taiwan was a study to apply Kurt Lewins change theory to examine the
Nursing Informatics development in Taiwan. Lewins change theory includes three stages:
unfreezing the current level, changing or moving to the new level, and refreezing at the new
level. The first stage, unfreezing, involves the identification of the current need or problem. The
second stage is when the change occurs. The third stage is Refreezing in which the healthcare
team adopts to the new norm.
Before 2002, nursing informatics in Taiwan was scattered and unsystematic. The nurses
seem conservative and afraid of technology. Significant nursing informatics development in
Taiwan started in 2002, there were many nursing informatics training programs by using Excel
VBA program for the clinical nurses, nursing managers, nursing students and etc. More than 300
nurses have attended these programs. This established the Taiwan Nursing Informatics
Association (TNIA) in 2006. Lewins change theory was used as the theoretical framework and
informatics competency for nurses to examine and determine current achievements and future
strategies. The data were collected from 2002 to 2008.
The nursing informatics competency frameworks are used to examine what has been
done in Taiwan. The nurses in Taiwan have worked for improving the computer skills,
informatics knowledge and informatics skills and encouraged to set up nursing informatics
specialist in hospital. The next step is using more advanced skills to improve nursing informatics
and build up a role model. The challenge now for the nurses in Taiwan is to make nursing
directors and all nurses understand the importance of nursing informatics, and develop the
systematic educational programs and strategic plans to expand and deepen the nursing
informatics.
The Nursing informatics age in Taiwan is relatively young compared to some of the
western cultures but it is one of the leading countries promoting nursing informatics in Asia.
They have proven themselves to have remarkable development in the field. They constantly try
to improve the Nursing Informatics training and programs in the hospitals. They also try to keep
in trend with the new technological developments and produce more nursing researches each
year. They might be new at this field but they are showing great improvement.