ANA definition of nursing informatics:
"A specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice" [ANA, 2008, p. 1].
The longitudinal electronic health record [EHR/EMR] has become the ultimate goal of health care organizations.
Role in informatics
Informatics nurse [IN]—has experience in nursing informatics but does not have an advanced degree in the specialty
Informatics nurse specialist [INS]—has graduate level education in informatics or a related field
Nurses in both roles
•"...support consumers, patients, clinical 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, 2008, p. 1].
Informatics nurse [IN]
—has experience in nursing informatics but does not have an advanced degree in the specialty
Informatics nurse specialist [INS]—
has graduate level education in informatics or a related field
information technology
IN and INS must have basic knowledge of how a computer works
IN and INS must be able to converse with technology staff on intellectual level about hardware, software, communications, data representation, and security
IN and INS must be comfortable with software and hardware implementation, training, testing, and facilitating knowledge
What Are Regulatory and Accreditation Requirements?
HIPAA: ensures that health care organizations collect right data in common format
The Joint Commission: inspects and reviews variety of areas within each organization
HIPPA
Ensures that health care organizations collect right data in common format
Standards signed into law that protect the privacy and security of patient data
Health information
privacy law
Data security standards
Electronic transaction standards
Implications of mobile computing
Tablet computers and smartphones are creating new implications for protection of privacy and security
Individual rights expanded
•Patients can receive copy of their medical record in electronic form
The Joint Commission [TJC]
inspects and reviews variety of areas within each organization
Implemented information management [IM] standards in the mid-1990s
Total of 10 standards
Ensures that facilities are meeting high performance standards through certification
Need for information management regulation
Information management has been woven throughout the various standards and the National Patient Safety Goals.
is it ethical or is it not
How can I safeguard patient data when using high-tech handheld devices such as PDAs, tablet computers, and smartphones?
ØKeep careful physical control of the device at all times
ØUse data encryption technology to protect data
ØUse a password when turning on the PDA and a time-out to reactivate the password
ØDisable the infrared ports except during use
ØDo not send infrared transmissions in public locations [Pancoast and colleagues, 2003]
How can I safeguard patient data when stored on a mobile device?
ØKeep security software up to date
ØResearch mobile applications [apps] before downloading
ØUse adequate security to send and receive health information over public WiFi networks
ØDelete all stored health information before discarding or reusing the mobile device [Pancoast and colleagues, 2003; U.S. Department of Health and Human Services, 2013]
Nomenclature classification and taxonomy
Recognized systematic classification and consistent method of describing nursing practice—descriptors or labels
Taxonomy—study of classifications
Without a common language, data cannot be aggregated into useful terms
What are normal limits
Taxonomy
—study of classifications
EHR
EHR is part of CIS
Web-based system
Handheld or wireless system
EHR is different from electronic medical record [EMR]
Focus on total health of the patient
Goes beyond standard clinical data collected during a single visit to the hospital or physician's office
Intended to share information with other providers involved in the patient's care
Computerized provider order entry [CPOE]
Patient care orders entered directly into computer
•Reduces medication transcription errors
•Increases transmission and processing time from pharmacy
Clinical decision support systems
Improves patient outcomes
Promotes patient safety
Reduces financial costs incurred by health care facility
Using the internet
Next generation of health care delivery
Health information on the Internet can dramatically improve patients' ability to manage their own health—but users must remember to proceed with caution!
Reputable Sites
Office of the Surgeon General
National Human Genome Research Institute [NHGRI]
Centers for Disease Control and Prevention [CDC]
Agency for Healthcare Research and Quality [AHRQ]
Health Resources and Services Administration [HRSA]
CARS
CARS—another tool designed to help you evaluate a website
Credibility—authoritative source?
Accuracy—correct today? last updated?
Reasonableness—engages subject thoughtfully, reasonably, truthfully?
Support—triangulated sources?
Remember café—advice for dealing with information obtained from the Internet:
Challenge information and demand accountability
Adapt and require more credibility and evidence for stronger claims—be skeptical of information
File new information in your mind rather than immediately believing or disbelieving
Evaluate and reevaluate regularly—recognize dynamic, fluid nature of information
What does informatics consist of in your nursing practice?
A. Use of a mobile workstation
B. Barcode devices for medication administration
C. IV pumps
D. Utilization of clinical decision support systems
...
DIFFERENT TYPE OF LEADERS
Know for the exam
Attributes of a leader
Visionary
Flexible
Successful
Motivates others to change
Role model
Creator
Planner
Confident
Proactive
Lewin change theory
unfreezing, moving, refreezing
must go thru them all to make change necessary
Unfreezing
±Prior to change.....we must BELIEVE it is necessary
±Only implement change for a good reason
±"Change for change 's sake" is not a reason
Movement
±Change agent... driving forces exceed restraining forces
±Implement change gradually.....
±Changes in human behavior, attitudes, perceptions.....lengthy---need time
make sure change happens, even tho you meet resistance
Refreezing
±Change agent stabilizes the change... integrated into the status quo
±If refreezing incomplete, the change --- ineffective and the behaviors that occurred prior to the change will resume
±Change agent--- supportive and reinforce efforts of the people affected by change
reevaluate and ask if change is being carried out, might need to reeducate
change takes how long to accept
3-6 months REEVALUATE HERE
Rational-empirical strategies:
resistance to change comes from ignorance or superstition but people will change when presented facts for need to change
Used when little resistance is anticipated or when change is taken as reasonable.
rationale
Normative-reeducative strategies:
influence by teaching
Use of group norms to socialize and influence people to bring about change
Interpersonal skills
Power-coercive strategies:
Use of power by legitimate authority, economic sanctions, or political clout
Enactment of new laws; groups---strikes
Example of using all three
smoking:
1] present facts: this
isnt good for other people if you smoke in the car
2] friends and family influence: peer pressure
3] won't ride in car if smokes, etc.
±How change is accepted is going to depend on staff's values, education, culture, social background, and experiences [+ or -] with change
Old way--autocratic---opposition--passive aggressive and overt [refusal]-----wasted energy
New way---workers to speak openly about change---so managers can determine how to overcome objectives
Integration of Leadership Roles and Management Functions in Planned Change
±Manager-understand planning process and standards----and apply---mechanic
°id. situations where change is needed---assess driving and restraining forces
first thing we do to implement change
make them believe
Which statement by the nurse indicates an understanding of the definition of nursing
informatics?
a. "Nursing informatics is a specialty area of hospital nursing in which management of patient care is done via computers."
b. "Nursing informatics is the specialty practice of nursing integrating nursing
science with information management."
c. "Nursing informatics includes the input and retrieval of a patient's complete medical history via electronic data."
d. "Nursing informatics is an area of computer system design and analysis to provide
and retrieve patient health data during the period of hospitalization."
B
What is the importance of using classification systems for nursing nomenclature to describe
nursing practice?
a. To provide a system to develop and use a patient care management
system
b. To allow nursing administration to project, define, and implement nursing care policies and guidelines
c. To assist the quality control team to survey and gather data that will reflect the acuity classification of patients
d. To facilitate the collection of consistent data that can be accurately manipulated in
an electronic medical record
D
Which statement by the nurse indicates an
understanding of general systems theory in regard
to nursing informatics?
a. "General systems theory organizes interdependent parts that, when working
together, can produce a product that none used alone could produce."
b. "General systems theory provides theory support for a system that maintains
confidentiality when handling patient data and information."
c. "General systems theory incorporates external databases from state agencies to
allow for performance comparison
within a specific institution."
d. "General systems theory is a nursing theory regarding the use of nurse informatics
to integrate the systems within health care for support of nursing education and
practice."
A
Which of the following statements indicates that the nurse's understanding of the difference
between the electronic health record [EHR] and electronic medical record [EMR] is
accurate?
a. "EHR provides nursing with a standardized nomenclature of taxonomy to record
nursing care."
b. "EMR is the inclusion of only data collected by the patient's personal health record
[PHR]."
c. "EHR is a longitudinal record of the patient's health information."
d. "EMR allows nurses to document nursing care in a system that is intuitive to their level of computer literacy
C
A nurse is
educating students on how to evaluate a website. The nurse judges the teaching to
be effective when the students can state
a. "Internet information must go through careful screening before it can be posted."
b. "Credibility, accuracy, and reasonableness of the information should be considered."
c. "It is important to have the hospital librarian verify the authenticity of the website."
d. "Most Internet information can be downloaded or beamed to a smartphone or handheld device [personal digital assistant [PDA]]."
B
The nurse is educating a nursing student on the difference between the informatics nurse and
the informatics nurse specialist. The teaching has been effective when the nursing student
states which of the following?
a. "The informatics nurse has a graduate degree."
b. "The informatics nurse specialist has experience in informatics but no
advanced
degree."
c. "The informatics nurse supports consumers."
d. "The informatics nurse specialist has an advanced degree."
D
A nursing student is interested in the field of nursing informatics. What would the student do
to prepare for a career in this specialty as a nurse leader?
a. Obtain a baccalaureate degree in nursing.
b. Complete 5 years on a medical-surgical unit.
c. Obtain
critical care experience.
d. Obtain a graduate degree.
D
The nurse has an adequate understanding of the informatics nurse [IN] and informatics nurse
specialist [INS] when making which of the following statements?
a. "The IN/INS does not require any computer or network knowledge on entry into
the profession."
b. "The IN/INS does not interact directly with clinical staff."
c. "The IN/INS does not
need prior knowledge of software or hardware
implementation."
d. "The IN/INS should be prepared to help with system implementation."
D
A nurse is learning about the role of the informatics nurse/informatics nurse specialist. The
nurse learns which of the following pertains to this role and data security?
a. "The IN/INS may help write data security policies."
b. "Investigating data breaches will be
the primary job of the IN/INS."
c. "This is such a new role, no real outcomes for it exist yet."
d. "The IN/INS will be the lead person on technology development."
A
How can the nurse expect to be impacted by nursing informatics?
a. The nurse would not be directly impacted unless he or she worked in nursing informatics.
b. Nurses at the bedside are minimally impacted.
c. Nurses are impacted by the use of barcode medication administration.
d. Nurse managers are the only hospital staff who are impacted.
C
Which action can the nurse take to evaluate an Internet resource?
a. Assume that the resource is credible if it is on an Internet page.
b. Determine if the resource provides evidence for claims made.
c. Assess the popularity of the resource.
d. Determine the date the resource
was published; older material is more reliable.
B
The nurse understands the benefits of Computerized Provider Order Entry [CPOE] when
stating
a. "CPOE does not change the process of patient care."
b. "CPOE averts problems with handwritten orders."
c. "CPOE benefits only the nurses in the health care system."
d. "CPOE benefits only the pharmacists in the health care system."
B
How does the IN/INS use HIPAA regulations and TJC requirements in daily practice? [Select
all that apply.]
a. Investigation of violations
b. Writing of policies
c. Involvement in the discipline process
d. Writing of procedures
e. Managing the nursing unit
A
B
D
The nurse has adequate understanding of HIPAA when
stating that the major impact from this
privacy regulation is in [Select all that apply.]
a. "health information privacy law."
b. "bedside nursing care."
c. "nursing report communication."
d. "data security standards."
e. "electronic transaction standards."
A
D
E
A nurse manager is educating a group of staff nurses on violation of HIPAA standards. The
manager judges the teaching to be
effective when one of the staff nurses states [Select all that
apply.]
a. "Violations of HIPAA standards no longer occur because the consequences are so
severe."
b. "Violations of HIPAA standards can result in termination of employment."
c. "Violations of HIPAA standards can result in an indictment."
d. "Violations of HIPAA standards are waived if it is your first offense."
e. "Violations of HIPAA standards can result in prison time."
B
C
E
Which actions by the nurse incorporate standard practice for protecting patient privacy on
mobile devices? [Select all that apply.]
a. Keep careful physical control of the device at all times.
b. Avoid the use of mobile devices.
c. Use a password and a time-out to authenticate the reactivation.
d. Enable encryption.
e. Keep security software up-to-date.
A
C
D
E
A nurse manager is lecturing staff nurses on the barriers to the full integration of health
information technology. The nurse manager judges the teaching to be effective when a staff
nurse states [Select all that apply.]
a. "Barriers include lack of standardization across care areas."
b. "A barrier to the full integration is funding."
c. "Currently there are no barriers."
d. "A current barrier is privacy laws."
e. "Barriers to full integration are not likely
to be overcome."
A
B
D