Heidi Cardenas, eHow Contributor

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Informatics is the process of advancing in a discipline with a combination of data, information and knowledge. Nursing info
By

Informatics includes machinery.

Problems With Nursing Informatics

rmatics encompasses the devices, machines, resources, and methods of utilizing

information, computers, and nursing science in nursing. It's a recognized specialty for registered nurses, but does present challenges that academics and medical practitioners are working to improve or eliminate.

Significance
In 2007, the Healthcare Information and Management Systems Society Nursing Informatics
Awareness Task Force estimated that 50 percent of a nurse's time is spent on documentation. Because of explosive strides in information technology and the huge body of medical knowledge amassed, controlling medical errors and health care costs are paramount in the health care professions, including nursing. According to RN Journal, handwriting on a piece of paper has been largely replaced by reports from medical devices at the point of care, and nurses have to master electronic documentation.

Function
Nursing documentation is complex and situation-dependent. With different technology and medical charting methods in use, consistent education and training on documentation is difficult to achieve, especially electronically.

Research
Concerns and controversies over privacy issues have challenged the health care industry regarding electronic medical records. In President Obama's first weekly address in January 2009, the U.S. government plans to "computerize the nation's health record in five years, saving billions of dollars in health care costs and countless lives," but the National League for Nurses found in 2008 that new nurses need programs to support their work in informationintensive environments. The informatics nurse specialist role was first credentialed in 1995 to ensure nurses will be qualified to work with computerized medical data.

Considerations
There is no single device that generates a comprehensive patient record, stores it and makes it accessible to care providers in different locations. Bar codes on medicines, computerized physician order-entry, automated scheduling systems for nurse administrators, nursing

student preparation for IT tools and HIPAA concerns are just a few of the problems in nursing informatics.

Potential
Mobile devices, communication technologies, efficient applications, and enhanced workflow and documentation will be the norm going forward and in the future. Ideally, every nurse would learn a universal IT platform for all patient care, but that is an almost unobtainable goal with the rapid advances in research, medicine and information technology. One thing is certain---nursing and information technology are integrally intertwined and will remain so in the future.

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Advances in computer-based technology have become an important aspect of nursing research. With emphasis on innovation in research by funding agencies, including the National Institutes of Health, nurse researchers are attracted to innovative computer technologies. Computer technology may be viewed as an innovative aspect of a nursing study when the rationale for using it is clear and solid. However, computer technology may be viewed as a methodological flaw if the rationale for its use in a specific study is weak. For example, the Internet is frequently used as a survey tool in nursing research. Computer technology research components would be worthy of the designation "innovative" if the Internet can provide better access to research participants residing in geographically dispersed areas nationally or internationally or if it can provide a better medium for exploring a specific nursing phenomenon, especially a stigmatized condition (e.g., drug abuse, sexual abuse, cancer, HIV infection, rare genetic problems, etc.). However, if the rationale for including computer technologies in a specific study is not strong or the study could be more effectively conducted using conventional research methods (e.g., pen-and-pencil surveys, mail surveys, and telephone surveys), use of the Internet may detract from the study. There are general guidelines for the use of the Internet in research. First, researchers should carefully consider the rationale for incorporating computer technologies in their studies, looking at both the advantages and disadvantages of using a specific computer technology. Consulting with experts will provide insights on the pros and cons of using computer technologies in a specific study. Second, although many studies use computer technologies, potential issues in using the technologies are still being discovered. Thus, researchers should be aware of and sensitive to potential unexpected issues throughout the research process. With the daily advances in computer technologies, researchers frequently encounter unanticipated problems. Indeed, many issues related to security, authenticity, self-reporting, comparison of computer-based instruments to conventional instruments, and contraction with commercial bodies providing computer technologies have been reported. Finally, researchers should be conscious of the limitations of the specific computer technology that they adopt and work to resolve them. For example, current computer technologies may not provide high-resolution images of pictures taken in clinical or home settings, which may be essential for health assessment and monitoring of a specific health condition. Thus, researchers who want to use image transfers need to consider how to supplement and strengthen this strategy using other computer technologies or other design strategies in their health assessment and monitoring process. Throughout our history, new ideas and technologies have been welcomed, carefully critiqued, and discarded or accepted by nurse researchers to advance nursing science. Our efforts to adopt new computer technologies to advance nursing science for better nursing care will continue, and these efforts will require critical minds and careful consideration of the benefits and disadvantages of using them.

Abstract Video technology is becoming more popular as a research tool because it has unique features that capture accurately and comprehensively the nature of nursing phenomena. Video technology is used extensively in nursing as an educational tool or intervention, a means of monitoring quality assurance standards, and as tool to collect research data. Videotaping is useful because is provides continuous multi-media, multisensory information about the subject and its context. Credibility for video data is based on the question of to what extent do the data or results adequately represent true behavior. The three main issues in video research that impact the credibility of data are observer bias, participant reactivity to knowledge of being videotaped, and maintenance of consistent data quality. Not all threats to credibility can be overcome. The key is to acknowledge insurmountable problems, to consider their limitations in data analysis, and to evaluate and report their effects.

Advantages

The Impact of Technology in Nursing Colleges

By Abby Hall, eHow Contributor updated: July 03, 2010
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Technology has had a significant effect on the curriculum provided by nursing colleges.

Technology is an important component of the health care field because doctors, nurses and medical specialists use technology in the diagnosis and treatment of health problems. Graduates of medical and nursing programs must be knowledgeable and comfortable using this technology. The growth of technology has forced many nursing schools to change their curriculum and embrace the effects that technology has had on their programs.

Better Graduates
Nursing programs help develop students who are better prepared to enter the health care field by using patient simulators in the classroom. These simulators can be programmed to change blood pressure, breathing rate, symptoms, temperature and other body functions in response to the care a nursing student is providing. Instructors can allow nursing students to make errors that cause the patient simulator to go into cardiac arrest or die. This often educates the student more than when the instructor interrupts before they make the error.

Online Degrees
Nontraditional students make up a significant portion of the student population in nursing
colleges. Technology allows these students to earn their degree while managing the demands of work and family. Nursing classes are offered online with students learning nursing procedures through textbooks, videos and attending nursing skill labs at arranged times. The clinical experience is the only portion of the degree that students must complete in person.

Bridge Programs
Technology has made it possible for many nursing colleges to offer bridge programs for students. Students in these programs have completed some type of degree or training, and now want additional education to secure a better position in the health care field. Common bridge programs include licensed practical nurse to registered nurse or bachelors of science degree in nursing to a masters of science degree in nursing. The former allows a person to move up from an LPN to an RN while the latter takes the person from an RN position to serving as a nurse practitioner. Generally these bridge programs work through a mixture of online classes and in-person clinicals making it possible for students to work in the health care field and still attend school.

Costs
Incorporating technological advances into nursing programs has dramatically increased the operating costs of these institutions. Patient simulators, such as the one sold by Laerdal, cost about $30,000 for one dummy and the simulation scenarios for it, as of July 2010. Budgets for nursing education are often limited making it difficult for nursing programs to grow and expand without funding from grants, private donors or foundations.

Drawbacks
The nature of medical technology often makes it difficult for nursing schools to keep up with changes and provide the latest equipment for students to train on. Many nursing programs are forced to train students on older equipment that is donated by hospitals or other health care facilities when they upgrade their equipment.

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Abstract Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.

Nursing Informatics

Nursing Past, Present and Future Nursing Informatics is not new,

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but it certainly is NOW! Technology is dramatically altering the ways in which we diagnose, treat, care for and manage patients. It is our past and it is our present. Our Mission is to support evidence-based nursing practice and improved patient outcomes with technology solutions that enhance nursing communication, documentation and efficiency. We pursue our mission endlessly and passionately! Nursing leadership at Cleveland Clinic has long recognized that superior quality of care depends on the alignment of people, processes and technology. The Department of Nursing Informatics -within the Nursing Institute- plays an essential role in defining and implementing the strategy for innovative technological systems and processes to support the delivery of quality patient care and to enhance nursing practice. Nursing Informatics participates in multidisciplinary strategic planning to determine system solutions that support patient care, set standards for clinical applications, conform to accreditation standards and regulatory requirements and transform clinical practice. The department also facilitates the development of automation policies, procedures and guidelines for nursing and is the primary liaison between the Cleveland Clinic Information Technology Division and the Nursing Institute. At the onset of the department, information technology needs within the Nursing Institute were focused on supporting mainframe applications, developing databases, maintaining desktop applications and deploying office computers. It was during this time when various clinical systems were beginning to evolve, and a clinical nurse manager - interested in how technology could affect nursing practice and patient care - became the first manager of the department. With the advent of an automated order entry/results reporting system, the role of the department quickly expanded along with the staff. Initially referred to as Nursing Information Systems at its inception in 1988, the area was officially established as a department in 1993 one year before the American Nurses Association recognized Nursing Informatics as a specialty with ANCC Certification. The name change to Nursing Informatics was implemented in 2006 to coincide with then-current standards of practice and scope. The Nursing Informatics department is now comprised of registered nurses, educators, systems analysts, a web analyst, a security coordinator and system administrators whose focus is to enhance nursing practice through the creative use of technology, maximizing nursing productivity, improving the work environment infrastructure and further supporting the Clinics world class excellence in patient care. Nurses First We bring our passion for nursing and our passion for innovation together to improve the way nurses communicate with one another, with other caregivers and with patients. Informatics nurses see technology as a tool to support, rather than hinder, their love of nursing as well as impact future nursing practices. For this team, technology is leveraged for the benefit of nursing practice and improved excellence in patient care systems and processes. Informatics nurses routinely support staff in using automated applications in their daily assignments on the units and play an important interdisciplinary role that combines their passion for nursing with their love of technology, bringing a nursing perspective into the evaluation of innovative systems so that positive patient outcomes are achieved on all levels. Champions for Change Not just change for the sake of change. How can we ensure patient satisfaction, safety and outcomes? How can nursing staff leverage technology to improve the environment for providing exceptional nursing care? Thats our passion! Clinical Analysts in the Department of Nursing Informatics are Registered Nurses who assess opportunities for innovative technology to improve clinical practices by first analyzing clinical workflow to determine current practices. Based upon these observations, they facilitate the design and development, testing, implementation, training and evaluation of automated clinical systems. Informatics Clinical Analysts facilitate work groups from the nursing staff to validate the application design and to study and quantify technology impact on improvement of specific nursing practices and processes. Collaborative Approach to Nursing Education, Quality and Research Clinical Instructors in the Department of Nursing Informatics are also nurses - providing centralized application training to nursing staff in support of new or revised clinical applications implemented on the nursing units. Working collaboratively with the nurse managers, nursing staff, and the Department of Nursing Education & Professional Development - NI Clinical Instructors provide instruction and user support to ease the introduction of new technology into nursing care workflows. Classes favor independent learning with directed computer lab environments as well as self-directed exercises, but also incorporate computer-based training a component still evolving from yearly competencies and training in federal regulations to clinical applications training with competency assessment. Unit nursing staff responds positively to the computer-based training, which can be taken at times most convenient to them even from home. The progressive evolution to electronic documentation of the medical record not only improves access to patient information at the point of care, it also greatly enhances nursing abilities to benchmark, monitor, audit and report quality measures in support of CMS, The Joint Commission and MAGNET initiatives. Additionally, collaborative nursing-led research is enhanced by the ability to support these projects with patient data that is more easily extracted electronically. Supporting these efforts and initiatives is a dedicated team of clinical and system analysts who provide support for the development and management of information databases, systems and processes to bring efficiency to nursing-driven quality and research endeavors through informatics. Maintenance and support of all databases and desktops is provided with a team of system administrators within the department of Nursing Informatics whose efforts are driven by a strong sense of ensuring employee satisfaction through greater efficiency. Innovative Use of Technology Improves Employee and Patient Satisfaction The Department of Nursing Informatics encourages nursing staff, patients and their families to suggest ideas for greater patient satisfaction. The department supports the resulting suggestions as much as is feasible and to that end, has made computers available for patients who have extended hospital stays. Dedicated solely to patients and their families, the computers provide access to the Internet for e-mailing friends and loved ones, interaction with support groups, researching information or playing computer games. All Cleveland Clinic nursing staff have an email account in addition to access to the Nursing Institute Intranet site complete with Cleveland Clinic policies and procedures, clinical references, announcements of educational classes and opportunities for professional growth, hospital and nursing award opportunitieseverything the nursing staff needs to know in a comprehensive,

easy-to-access site. In 2006, wireless Voice-over-IP (voice carried over internet protocol networks) phones were implemented in all nursing units to facilitate ease of communication and coordination of patient care between staff, physicians, ancillary departments and patients. Voice-over-IP technology is the most state of the art telecommunications methodology available commercially today and is fast becoming the standard for voice communications globally. The results improved communication and enhanced efficiency to improve patient care and satisfaction. Taking Patient Care to New Levels The implementation of the electronic medical record, as with other Cleveland Clinic approaches to clinical medical practice, sets a high standard for innovation, collaboration and interoperability. Nursing Informatics, in collaboration with the Information Technology Division, is implementing an electronic medical records system from Epic Systems of Madison, WI. Electronic documentation of the patients medical record is transforming clinical practice for nursing, allied health and medical practitioners at the Cleveland Clinic. After using EpicCare successfully in ambulatory outpatient services for two years, the Clinic is currently undergoing a phased implementation of the Epic system in the inpatient setting enabling health care providers to examine any patient record across the entire continuum of care in all Cleveland Clinic facilities. The current implementation includes Provider order entry (CPOE), nursing care documentation, medication dispensing and administration, and results reporting. Cleveland Clinic patients may even access their own records and request prescription renewals via the internet with MyChart. Nursing of the Future Technology and the effective use of it is our future. The future of nursing and Nursing Informatics is in alignment with the future of healthcare growth in the use of technology to ensure safety, positive outcomes and satisfaction of patients. Nursing is at the forefrontof this wave of technology innovation. A visionary nursing project currently in place at the Cleveland Clinic is the Nursing Institutes Nursing Unit of the Future - a collaborative project between the Nursing Institute and Information Technology Division. Established on a foundation of defining the ways in which people, processes and technology can improve patient outcomes and nursing practice, the Nursing Unit of the Future staff evaluates the feasibility of innovative mobile devices, applications and other communication technologies that have the potential to support enhanced workflow, documentation of patient care and the satisfaction of patients and staff. The Nursing Unit of the Future provides nurses with an opportunity to experience, assess benefits and provide feedback regarding new information technologies prior to implementation house-wide. As the nurses evaluate the clinical efficacy of devices and applications, the Nursing Informatics team also evaluates technical and clinical outcomes criteria including: How devices withstand normal wear and tear How easily information is gathered and recorded User friendliness Clinician satisfaction Time efficiency versus existing methods Impact on patient safety Impact on patient satisfaction Impact on caregiver satisfaction Flexibility for the Present The Nursing Informatics specialty at the Cleveland Clinic offers a wealth of benefits for experienced nurses who like Challenge Professional and Personal Growth Flexibility and Creativity A Supportive Team Environment Reward and Recognition Educational Support. A Professional Informatics Career Ladder An Informatics Development Program More Promise for the Future The future holds rapid and ongoing paradigm shifts for clinical caregivers, especially in the areas of electronic documentation, physician order entry and the collaborative transformation of clinical practice. Technology holds the promise to eliminate redundancy, aggregate relevant information in easy to access and read formats and improve caregiver efficiency, as it enhances nursing practice and drives improvements in patient quality outcomes. For Cleveland Clinic nurses, the future promises an explosion of new information technology that includes, among othersimplementation of RFID technology and personalized electronic scheduling and automated patient acuity classification. These technology advances and others yet to be defined are focused toward keeping Cleveland Clinic nurses at the forefront of quality care delivery and the Destination for Nursing Practice. More Information about the Nursing Informatics Specialty: What is Nursing Informatics?

Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and
communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology. (ANA Scope and Standards of Nursing Informatics Practice, 2001, pg vii) The ANCC Nurse Informatics Certification was established in 1994. There are currently more than 680 (ANCC, 2007) certified nurse informaticists in the United States.

How and where do I start to become an Informatics Nurse Specialist?

American Nursing Informatics Association (ANIA) Capital Area Roundtable on Informatics in Nursing (CARING) Healthcare Information Management Systems Society (HIMSS) - Nursing Informatics Community
Talk to Nursing Informatics specialists in your own hospital/health system Speak with nursing informatics faculty at your school of nursing Explore nursing informatics organization sites for additional educational resources and opportunities.