Nursing Informatics

1. Nursing Informatics Dr. Belal Hijji, RN, PhD November 28 & 29, 2010

2. Learning Outcomes At the end of this lecture, students will be able to: • Identify the various roles that computers play in nursing education, practice, management, and research. 2

3. COMPUTERS in NURSING EDUCATION • Computers are used extensively in nursing education; libraries are computerised, nursing educationalists use computers in classroom teaching and for academic record keeping. • In nursing education, computers are used in teaching and learning, testing, and student and course record management. Each of these are described next. 3

4. Teaching and Learning • Computers enhance academic performance for both students and faculty through facilitating access to literature, computer-assisted instruction, classroom technologies, and distance learning. • Literature access and retrieval: computers have significantly improved our abilities in keeping abreast of the information on any subject. In a fraction of time, continuously updated cumulative indexes of subjects can be searched electronically. • Once a list of search matches is displayed on screen, the user can select all or certain citations and either print them or store them on the hard disk. 4

5. Acquired Immune Deficiency Syndrome information onLINE (AIDSLINE) CANCER LITerature (CANCER LIT) Cumulative Index to Nursing and Allied Health Literature (CINAHL) Educational Resources Information Center (ERIC) Medical Literature Analysis and Retrieval System (MEDLARS) Mental Measurement Yearbook Psychological Abstracts (PsychINFO) • The text below lists commonly used bibliographic systems and databases. 5

6. Computer-Assisted Instruction (CAI) • Many software programmes help students and nurses learn and demonstrate learning. These include drug dosage calculation and ethical decision making. • Examples of tutorials include ECG interpretation, drug interactions, and legal aspects of nursing. • Completion of CAI programmes may be an acceptable means of demonstrating continuing education activities. For example, nursing faculty can obtain a certificate from the National Institute of Health (NIH) regarding the protection of human subjects in research. 6

7. Classroom Technology • New educational buildings are wired to accommodate technology. This includes electric outlets and wireless technology for network or Internet access. • For nursing faculty, liquid crystal display (LCD) panels allow computer screens to be displayed to the entire classroom. 7

8. Testing • This is the second use of computer in nursing education. • Surveys, including anonymous questionnaires, can be completed online. • For testing, large banks of potential items can be written and the computer can generate different exams for each student depending on the selection criteria. Students’ answers can also be scored electronically and the exam results analysed quickly. For example, the National Council Licensure Examination (NCLEX-RN) moved from paper and pencil tests to computer tests. 8

9. Student and Course Record Management • Computers are useful for maintaining results of students’ grades or attendance, for example al Zajel. The computer programme can calculate percentages, sort student scores in order, and print results for both students and faculty. • Students are frequently asked to evaluate faculty and courses. These data are also scanned into the computer so that cumulative results can be calculated and stored. • Many schools have now all student records on computer. From application through graduation, the registrar’s office keeps track of names, addresses, courses taken, grades, and all other important data. 9

10. COMPUTERS IN NURSING PRACTICE • Computers help nurses collect, record, and use client’s data. • Nurses maintain client’s data in computer records, assess other departments’ information about him/ her, and use computers to manage client schedules. 10

11. Documentation of Client Status and Medical Record Keeping • Computer can help nurses in service in their daily activities by reducing the amount of time needed to record in the client’s file, to access data about the client that may be somewhere in the file or elsewhere in the health institution. • Computers can help nurses in accessing standardised forms, policies, and procedures. • Within the context of the above title, we will discuss next bedside data entry, computer-based client records, data standardisation and classification, and tracking client’s status. 11

12. Bedside Data Entry • Bedside data entry systems allow recording of client assessments, medication administration, progress notes, care plan updating, client acuity, and accrued charges.

13. Computer-Based Client Records • Computer-based patient record (CPRs) allow client data retrieval by caregivers, administrators, accreditors, and others who require the data. • CPRs can improve a client’s health in four ways. • Constant availability of client’s health information across the life span. • Ability to monitor quality of care. • Access to stored data. • Ability of clients to share in knowledge and activities influencing their health. • One of the concerns with the CPRs is maintaining a client’s privacy and security of data, which can be protected by user authentication via password or retinal scans.

14. Tracking Client’s Status • Once a CPR has been established, the nurse can retrieve and display a client’s physiological parameters across time. For example, this includes vital signs. • Standardised nursing care plans and care maps can be stored in the computer and easily placed in the CPR electronically.

15. COMPUTERS in NURSING ADMINISTRATION • Human resources: Employers must maintain a database, computerised or not, on each employee. Data held about each employee include demographics, salary, life support certification, health requirements, and performance appraisals. • Medical records management: Medical records reflect costs. While it is expensive to keep records, it is even more expensive not to be able to access what is in them. Nurses, therefore, need to search client record for trends including most common presenting diagnoses, most expensive cases, length of stay, and client outcomes.

16. Facilities management: Computers can facilitate many aspects of managing building and non-nursing services. This means that computers can control heating, air conditioning, ventilation, and alarm systems. Security devices such as readers that scan identification cards and bar codes permit only authorised staff to enter private areas. • Budget and finance: Advantages of computerised billing are that claims are transmitted much more quickly and have a greater likelihood of being complete and accurate compared to hand-written documents. • Quality assurance: Both internal and external stakeholders need to know that the services of a health care organisation have positive results.

17. Accreditation: The joint Commission on Accreditation of Health Care Organisations (JCAHO) requires hospitals to have online mechanisms to monitor quality indicators, so as to reduce the difficulty and time involved in the accreditation process. Another aspect of accreditation review is demonstrating adequate staffing levels for the number and acuity of clients. Each health care facility must use a method of determining the number of hours of nursing care required for its clients.

18. COMPUTERS in NURSING RESEARCH • Computers are invaluable assistants in the conduct of research. In each step of the research process, computers facilitate generation, refinement, analysis, and output of data. Computers are, therefore, useful in the following aspects of the research process. • Problem identification: This is the first step in the research process. The computer can help in locating the current literature about the problem. Researchers may be able to locate a solution, unknown to them, to the problem.

19. Literature review: An exhaustive review of the literature can be time consuming. Without computer access to electronic databases, the researcher must wade through huge volumes of publications. • Research design: The design of a research study, including the choice specific research method, is always driven by the research question. At the design stage the researcher determines whether the study will be qualitative or quantitative, data collection tools, the types of analyses that will be carried out on data to answer the research question. Computers in this stage can be used to search the literature for instruments that have already been developed.

20. Data collection and analysis: Computers enable the creation of instruments to be used for data collection. This may include informed consent, participant information sheet, and a questionnaire. • Research dissemination: Research is of limited value if the findings are not widely disseminated to nurses who can use them to improve clinical practice. Many journals require researchers to submit their manuscripts for publication electronically, for example the Journal of Clinical Nursing. Computers speed completion of a research project and the availability of findings to the readers.

21. PARTIAL PARTICIPANT INFORMATION SHEET Title of study Nurses' knowledge and practice of blood transfusion in 2 public hospitals, Nablus, Palestine. Introduction I am an Assistant Professor at An-Najah National University. This explanatory note will give information about this research project and what would be expected from you if you want to take part. What the study is all about The purpose of the study is to document current blood transfusion knowledge and practice among concerned nurses. Areas in need of improvements will be highlighted and recommendations will be made in order to deliver an effective and safe care to patients.

22. Research grants: Funds are available from many sources for nursing research. The budget asked for in the grant application form may include a request to purchase a computer and/ or software needed to carry out the project.