Running head: NURSING INFORMATICS 1

Nursing Informatics

GNRS 500

Azusa Pacific University

Professor Holt

David Staten

April 24, 2019

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Nursing Informatics

Technological advancements have modernized healthcare. Computer integration from the

1980s has led to nursing informatics (Thede, 2012). Nursing informatics integrated basic

computer skills, information literacy, and information management that are essential to modern

healthcare (Foster & Sethares, 2017). The purpose of this paper is to analyze the significance of

the past, present, and future of nursing informatics.

Nursing Informatic Foundations

The foundations of nursing informatic was started by Florence Nightingale (Betts &

Wright, 2009). Florence Nightingale nursed wounded soldiers during the Crimean War (Betts &

Wright, 2009). Nightingale realized that soldiers have been dying from preventable causes (Betts

& Wright, 2009). She utilized statistical data of wounded soldiers dying from unsanitary

conditions and overcrowding (Betts & Wright, 2009). She wrote that accurate statistics would

lead to improvements to medical and surgical procedures (Betts & Wright, 2009). Nightingale’s

statistical analysis influenced future nursing informatics such as Grave – Blum Model (Betts &

Wright, 2009).

Graves and Blum Model

Graves and Corcoran defined “nursing informatics as a management and processing of

nursing data, information, and knowledge” (Nelson, p.1, 2018). Procedural knowledge involves

the interaction between data, information, and knowledge to perform nursing tasks (Nelson,

2018). Bruce Blum’s taxonomy and definitions influence Grave’s Model (Nelson, 2018).

Blum defines the three components: a) data, b) information, and c) knowledge. Data is an

uninterpreted item such as age which is difficult to interpret without context of other data

(Nelson, 2018). Information is a group of data elements that are significant for a person to
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interpret (Nelson, 2018). Body mass indexes are an example of information that are calculated

with data elements such as height, weight, age, and gender (Nelson, 2018). Body mass index is

indicative of an individual’s physical health (Nelson, 2018). Knowledge involves understanding

interrelationships between data and information. (Nelson, 2018). Individuals that have a body

mass index of thirty being interpreted as healthy and not obese is an example of knowledge

(Nelson, 2018). Nurses utilize the Graves and Blum model to meet patient needs with medical

technology (Nelson, 2018). Graves and Blum model are used in electronic medical records

(Nelson, 2018).

Electronic Medical Record

The first electronic medical record is implemented in 1971 by clinicians and engineers

(Thede, 2012). Electronic medical records were successful in incorporating true integration,

workflow support, and ease of use (Thede, 2012). Different healthcare clinician processes

integrated electronic medication administration and ordering abilities (Thede, 2012). Clinical

words and phrases were critical components that promoted ease of use compared to

computational coding systems (Thede, 2012). The system design of electrical records is

implemented for nursing roles and nursing culture (Thede, 2012). A goal of nursing informatics

is to free nurses from excessive documentation and engage in quality patient care (Thede, 2012).

Modern Nursing Informatics Barriers

There are many barriers to overcome in the modern era of nursing informatics. Barriers in

the modern era include system integration, inadequate screen design, difficulty innovating new

informatic tools, and failure to implement informatic principles (Thede, 2012). Healthcare

agencies lack proper system integration (Thede, 2012). The systems for these agencies provide

automation for one department, but lack interfacing with other departments or systems (Thede,
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2012). The ideal system for integration includes data from every department (Thede, 2012). Non-

interfaced systems that require each department to enter the repetitive data can cause decreased

quality control (Thede, 2012). Nurses that enter repetitive data with non-interface systems

increase their risk for errors (Thede, 2012). Therefore, inadequate screen designs cause

technological inefficiencies (Thede, 2012).

Vendors and consumers need to create adequate screens for proper nursing use (Thede,

2012). Adequate screen design eliminates unnecessary information to promote increased

efficiency (Thede, 2012). In addition, screen designs include human-interface principles can

decrease or prevent data errors (Thede, 2012). Also, scanning of patient records into computers

results in innovation failures (Thede, 2012).

The practice of scanning patient healthcare records into digital records are difficult

compared to physical records (Thede, 2012). Information scanned are not retrievable in a

structuralized format (Thede, 2012). There is difficulty in scanning ineligible hand written

documents into computers (Thede, 2012). A method of converting handwritten documents to

computer text or extensive editing requires accurate translation (Thede, 2012). Nursing

informatics can utilize greater systems and implementation of informatic principles (Thede,

2012).

Failure to implement informatic principles are due to lack of cultural changes (Thede,

2012). A cultural shift from silo mentalities to multidisciplinary perspectives are required to

implement effective informatic principles (Thede, 2012). Silo mentalities create disparities

between different healthcare disciplines that affect patient care (Thede, 2012). Multidisciplinary

perspectives implement integrated processes that provide better patient care which require
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increased investments of time, money, and effort (Thede, 2012). Nursing informatic education

can provide innovative ideas and solutions to these barriers.

Nursing Informatic Education

Education for nursing informatics focuses on improving efficiency for an increasing

population (Honey & Procter, 2017). Nursing education prepares students to act as information

management that advocate for patients (Honey & Procter, 2017). Essential concepts of nursing

informatic education are communication, teamwork, nursing documentation, and legal/ethical

expectations (Honey & Procter, 2017). Initial focus of informatic education is performing basic

computer skills or task (Honey & Procter, 2017). The focus has shifted from performing basic

computer skills to understanding information management and informatic issues (Honey &

Procter, 2017). An initiative that improved nursing education for informatics is known as

Technology Informatics Guiding Education Reform (Noble-Britton, 2014).

The purpose of the Technology Informatics Guiding Education Reform (TIGER)

initiative is setting minimum informatics competencies for modern nursing education (Noble-

Britton, 2014). This approach is set for nursing leaders and educators to integrate technology and

informatics into nursing practices (Noble-Britton, 2014). The goal of this initiative is promotion

of polarity thinking that balances traditional methods with innovation and individuality (Noble-

Britton, 2014). This initiative promotes innovate technologies and sustainable transformation that

respects humanistic and individualized patient care (Noble-Britton, 2014). Nursing informatic

education requires differing strategies for different academic groups (Foster & Sethares, 2017).

Different strategies are required for faculty, undergraduate students, and graduate

students in implementing nursing informatics (Foster & Sethares, 2017). In addition, faculty

needs support from outside personnel or peers to master informatic competencies (Foster &
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Sethares, 2017). Faculty can integrate mastered informatic competencies into educational

curriculums (Foster & Sethares, 2017). Therefore, faculty without peers need to consult with

other educational institutions that provide training for informatic integration (Foster & Sethares,

2017). Institutions need to provide faculty members with informatic resources and tools to

effectively guide students (Foster & Sethares, 2017).

Strategies for undergraduate students include development of baseline informatics

competencies (Foster & Sethares, 2017). Undergraduate students need computer-graded

assessment tools for immediate feedback for implementing nursing informatics (Foster &

Sethares, 2017). Faculty can direct students to resources that help to develop baseline

competencies (Foster & Sethares, 2017). In addition, faculty can design specific informatic

content as students progress throughout college (Foster & Sethares, 2017). Another strategy to

implement are case scenario that increase in difficulty as students progress throughout college

(Foster & Sethares, 2017).

Faculty can implement two different strategies for graduate students (Foster & Sethares,

2017). One strategy for graduate students is information extraction from clinical data sets to

guide ethical decision making with computers (Foster & Sethares, 2017). Another strategy for

graduate students is language specific informatics that ensure activities have expected outcomes

(Foster & Sethares, 2017). The implementation of nursing informatics also includes educational

barriers.

Nursing Informatic Education Barriers

Nursing informatic education faces challenges, barriers, and classroom pitfalls that hinder

implementation of nursing informatics. One challenge of nursing informatic education is new

nursing roles that require working with technology (Honey & Proctor, 2017). Nursing roles are
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blurred which causes professional boundaries to overlap and increase workload (Honey &

Proctor, 2017). A division between service delivery and nursing preparation leads to delayed

response of curriculum design and service improvement (Honey & Proctor, 2017). Delayed

responses increase the construct of general nursing education that includes a lack of professional

identity (Honey & Proctor, 2017).

Barriers to implementing nursing informatics education include method of integrating

informatics, lack of support for informatic knowledge, and lack of collaboration within an

organization (Foster & Sethares, 2017). There are unclear methods of integrating informatic

competencies into nursing education (Foster & Sethares, 2017). A lack of support and training

faculty members results to unclear methods of integrating informatic competencies (Foster &

Sethares, 2017). A lack of collaboration within an organization result from faculty resistance due

to faculty discomfort with technology (Foster & Sethares, 2017).

Increase use of technology within classroom setting causes challenges to effective nurse

teaching and classroom management (Noble-Britton, 2014). Faculty need to ensure that devices

are used for educational purposes and not student leisure (Noble-Britton, 2014). Rules must be

established to limit classroom distraction from devices (Noble-Britton, 2014). Faculty need to

master technology skills to avoid technological issues or pitfalls (Noble-Britton, 2014).

Classroom issues with technology are faculty mastery over technology, classroom control, and

privacy/legal concerns regarding social media (Noble-Britton, 2014). Clinical nursing site issues

with technology are cellphone usage in patients’ rooms, cellphone pictures of patients or their

conditions, and recording patient conversations (Noble-Britton, 2014). There are two major

focuses for future nursing informatics.

Nursing Informatic Future

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The two major focuses for future nursing informatics are wisdom and research priorities.

Researchers for nursing informatics propose to add the concept of wisdom with Graves and

Blum Model (Nelson, 2018). Wisdom is defined as appropriate use of data, information, and

knowledge to implement patient focused care (Nelson, 2018). Wisdom includes integrating data,

information, and knowledge that is specific to the individual’s problem or condition (Nelson,

2018). Some nursing informatics experts believe that wisdom cannot be considered a function of

technology (Nelson, 2018). Other nursing informatics experts believe that nurses will incorporate

wisdom within professional values (Nelson, 2018).

Information systems become automated to produce data and information (Nelson, 2018).

Automated systems have decisional systems that support or provide decisions based upon data

(Nelson, 2018). In addition, humans prior to automated systems made decision based upon data

(Nelson, 2018). Artificial intelligence systems can process automated systems information to

create new knowledge (Nelson, 2018). The next question for nursing informatics would be

where would the application of wisdom fit in future automated and artificial intelligence systems

in nursing care (Nelson, 2018).

A survey explores the top ten research priorities for future nursing informatics (Alhuwail

et al., 2016). The top ten research priorities were listed respectively as big data science,

standardized terminology, educational competencies, clinical decision support, mobile health,

usability, patient safety, data exchange, patient engagement, and clinical quality measures

(Alhuwail et al., 2016). Big data science is defined as large and multidimensional data that are

analyzed and display patterns, trends, and associations related to health promotion with

computational technique (Alhuwail et al., 2016). Big data analytics compare effectiveness among

various areas such as research, personalized medicine, and more (Alhuwail et al., 2016).
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Standard terminology is the second highest voted after big data sets which indicates

applied terminology research are needed (Alhuwail et al., 2016). There are gaps between

integrated real-world terminology and numerous terminology that exist on national and

international levels (Alhuwail et al., 2016). Integrated terminology has assigned unique codes

that results in difficulty to compare data across different terminologies (Alhuwail et al., 2016).

This causes limited nursing data to be communicating among nursing professionals (Alhuwail et

al., 2016). There are needs to make nursing terminology and data exchangeable and standardized

to improve clinical practice and research (Alhuwail et al., 2016). The remaining eight priorities

are voted to improving general health policies, globally, by adopting health information

technologies (Alhuwail et al., 2016).

Conclusion

The overall purpose of this paper is to analyze the significance of the past, present, and

future of nursing informatics. The significance of past nursing informatics begins with Florence

Nightingale. Florence Nightingale’s statistical analysis is foundational to nursing informatics

(Betts & Wright 2009). The Graves and Blum Model has provided a core definition to nursing

informatics. Invention of electronic medical records enables healthcare professionals to

communicate, order, and search information at rapid speeds prior to computers. Nursing

informatic barriers and nursing informatic educational barriers exist in modern times. Possible

solutions are addressed for these barriers and challenges. Modern nursing informatic education

can prepare nursing students for future technological advancements and nursing role changes.

The future of nursing informatic influences research priorities and possible inclusion of wisdom

within Graves and Blum Model. Automated systems and artificial intelligence will influence the

future of nursing informatics.

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References

Alhuwail, D., Ali, S., Badger, K., Eler, J., Georgsson, M., Islam, T., Jeon, E., Jung, H., Kuo,

C.H., Lewis, A., Peltonen, L., Pruinelli, L., Ronquillo, C., Sarmiento, R., &

Tayaben, J. (2016). Nursing informatics research priorities for the future:

Recommendations from an international survey. Nursing Informatics. 222-226. doi:

10.3223/978-1-61499-658-3-222

Betts, H.J., & Wright, G. (2009). Observations on sustainable and ubiquitous healthcare

informatics from florence nightingale. Connecting Health and Humans. 91-95. doi:

10.3223/978-1-60750-024-7-91

Foster, M., & Sethares, K. (2017). Current strategies to implement informatics into the nursing

curriculum: an integrative review. Online Journal of Nursing Informatics, 21(3), 1-4.

Retrieved from https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db

=rzh&AN=128848070&site=ehost-live&scope=site&custid=azusa

Honey, M., & Protector, P. (2017). The shifting sands of nursing informatics education: from

content to creativity. Forecasting Informatics Competencies for Nurses in the Future of

Connected Health. 31-40. doi: 10.3233/978-1-61499-738-2-31

Nelson, R. (2018). Informatics: Evolution of the nelson data, information, knowledge, and

wisdom model: part 1. Online Journal of Issues in Nursing. 23(3). Retrieved from

https://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=27&sid=27db9881-1c51-45

54-b69d-cd16371ab782%40sdc-v-sessmgr03

Noble-Britton, P. (2014). Strategies to enhance nursing student’s use of informatics and

technology. The Journal of Chi Eta Phi Sorority. 6-11. Retrieved from 
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https://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=27&sid=27db9881-1c51-

45-54-69d-cd1637lab782%40sdc-v-sessmgr03

Thede, L. (2012). Informatics: Where is it? Online Journal of Issues in Nursing. 17(1). 1.

Retrieved from https://doi.org/10.3912/OJIN.Vol17No1InfoCol01