Published online: 2020-04-27

NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

Original Article

NURSING INFORMATICS
R. Ponchitra
Associate Professor, Hiranandani College of Nursing, Mumbai, Maharashtra.
Correspondence :
R. Ponchitra
Hiranandani College of Nursing, Knowledge Park, Hill Side Avenue, Hiranandani Garden, Powai , Mumbai , Maharashtra - 400 076.
Mobile : +91 91676 94489, Fax : +91 22 2570 1615, E-mail : ponchitra76@[Link]
Abstract :
Computers have opened for us a world of information. New and emerging technologies will continue to have an effect on the health care
delivery system. Nurses as a major player in health care, will be part of this ever growing era technology. A nurse must know generalized
applications such as word processing, as well as specialized applications such as clinical information system. Virtual reality (simulation)
and ubiquitous(every where) computing are emerging and being used in education and other areas in health care nursing knowledge
workers must be able to understand the evolving specialty, nursing informatics, in order to begin to harness and use the tools available
for managing the vast amount of health care data and information. This article mentions in detail about Nursing Informatics and
therefore highlights that nursing informatics capabilities be appreciated, promoted, expanded and advanced to facilitate the work of
the Nurse, improve patient care, and enhance the Nursing profession.

Keywords: Clinical Information System, Virtual reality, Ubiquitous computing

Introduction : the science of automating information interactions.

“The Future is here. It's just not evenly distributed…”
Nursing Informatics :
(William Gibson, Novelist and visionary)
“Nursing Informatics is the specialty that integrates nursing
Computers have moved from the realm of a “nice to know”
science, computer science, and information science to
luxury item to a “need to know “essential resource for
manage and communicate data, information, knowledge,
professional practice. Nurses are knowledgeable workers
and wisdom in nursing practice.” (ANA 2008)
who require accurate and up to date information for their
professional work. Trends in computing will affect the work Figure 2 : Nursing Informatics Model ( Turley. 1996)
of the professional nurses in areas beyond the
Nursing Science
development of Clinical Information systems.
Computerized patient Records, Research advances, new Computer Cognitive
devices, monitoring equipment, sensors and 'smart body Science Science

parts' will all change the way that health care is

conceptualized, practiced and delivered. Every nurse need Information
Science
to be computer literate. For health care professional's
Nursing
computer literacy requires having an understanding of Informatics
systems used in clinical
practice, education and EVOLUTION OF NURSING INFORMATICS
Access this article online
Quick Response Code research settings. l Nurses have been involved in “informatics” since the
1960s
Informatics :
l San Jose Hospital (1965): Nurses recorded their
The term was coined as a
observation on a check list which was then converted
combination of
into punched cards for computer entry
"information" and
l 1966 Institute of Living in Hartford: Nurses used
"automatic" to describe

Keywords: Clinical Information System, Virtual reality, 18

Ubiquitous computing - R. Ponchitra
 NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

machine readable pencil “bubble sheets” to document GOAL OF NURSING INFORMATICS is to get the....
patient status RIGHT information to the
l 1970s: Nursing Diagnoses researched and approved by RIGHT people at the
the North American Nursing Diagnosis Association RIGHT time to do the
(NANDA). RIGHT job at the
l 1974: Nursing research papers presented at an RIGHT Cost
international medical informatics conference
NURSING INFORMATION SYSTEMS (NIS)5 - is one of the
(MEDINFO)
major clinical systems and allows for assessment of the
o Four research papers on NI from the UK and one from
patient and the documentation of the care and teaching
US nurses adapting and implementing an
delivered.5
information system at the NIH
l 1979: The Journal of Nursing Administration features a TWO APPROACHES OF NIS5
monthly column on “automation in nursing”
l 1980: The term “Nursing Informatics” originated by 1. Menu driven screens- It presents content in pre

Scholes and Barber arranged categories that allow practitioner to select the

l 1 9 8 5 : N u rs i n g M i n i m u m D ata S et ( N M D S ) most applicable items. The categories are designed

researched/developed by Werley and Lang. around the nursing process from admission through to

l 1990: ANA House of Delegates recognizes the Nursing discharge based on the nursing diagnosis.

Minimum Data Set (NMDS). 2. Care Protocols- In this type of documentation, a specific
l 1992: NI approved as a nursing specialty by American protocol is selected based on the admission diagnosis.
Nurses Association (ANA) The protocol lists the elements of care to be initiated
l 1992: ANA Database Steering Committee formally and monitored during each patient day. The
recognizes four nursing vocabularies: documentation is related to the ability of the patient to
l 1995: ANA credentialing exam achieve the established daily protocol goals.

According to Thompson (2005), three main shifts catalyzed Standardized Nursing Terminology1:
Nursing Informatics: Without a standardized nursing terminology, it would
o Moving from centralized data storage to remain difficult to quantify nursing and the nursing
decentralized data access component of electronic health record systems would
o Moving from paper charts to electronic health remain at best rudimentary. ANA has recognized 13
records standardized nursing languages
o Moving from relying on memory to continuously
using information resources

DATA ELEMENT SETS SETTINGS CONTENT

[Link]-Nursing Minimum Data Set All Nursing Clinical Data Elements
[Link]-Nursing Management Minimum Data Set All settings Nursing Administrative data elements
[Link]-Clinical Care classification All nursing care Diagnoses, Interventions and out come
[Link]-International classification of Nursing Practice All nursing care Diagnoses, Interventions and out come
[Link] All nursing Diagnosis
[Link]-Nursing Intervention Classification All nursing Interventions
[Link]-Nursing Outcome Classification All nursing Outcomes
[Link] system Home care, Public Diagnosis ,Interventions, Outcomes
Health and Community
9. PCDS-Patient Care Data Set Acute Care Diagnosis, Interventions, Outcomes

Keywords: Clinical Information System, Virtual reality, 19

Ubiquitous computing - R. Ponchitra
 NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

DATA ELEMENT SETS SETTINGS CONTENT

[Link]-Perioperative Nursing Data Set Perioperative Diagnosis ,Interventions, Outcomes
[Link]-Alternative Billing Codes Nursing And Other Interventions
[Link]-Logical Observation Identifiers Nursing And Other Out come and Assesments
Names and Codes
[Link] CT-Systematic Nomenclature of Nursing And Other Diagnosis ,Interventions, Outcomes
Medicine Clinical Terms

All the 13 languages were designed to record and track the Disadvantages in Utilizing Nis5
clinical care process for an entire episode of care for 1. Charting may be longer due to need for review of
patients in acute, home or ambulatory care settings. The content prior to selection
use of standardized nursing languages has many 2. Wording may not be common to users language.
advantages for the direct care/bedside nurse. These Standard Dictionaries are not readily available
include: better communication among nurses and other 3. Pre established content and need to make sure
health care providers, increased visibility of nursing protocols are individualized for patients with
interventions, improved patient care, enhanced data comorbidities
collection to evaluate nursing care outcomes, greater
Types of Nursing Hit (health Informationtechnology)
adherence to standards of care, and facilitated assessment
Applications
of nursing competency
• Automation of documentation
– Nurse rounding tools
General Application Soft Ware For Nurse Leaders4 • Bar-coded Rx management
1. Communication software – provides link for access • Nurse staffing systems
between computer
• Tele Nursing
2. Database management system- for storing and
retrieving data Application of Nursing Informatics
3. Word processing software- to produce documents such Nursing Practice
as memos, letters, signs, books and resumes
• accesses, enters and retrieves data related to client care
4. Spreadsheets- to develop budgets, maintain staff
via available hospital or nursing information systems
record, calculate, track and create graphs on statistics
relating to staff and patient data • uses computer applications to plan Computer-
5. Personal Information Manager Applications – contains generated nursing care plans ,Order entry, results
address book, calendar, email, a journal, notes and reporting, documentation and clinical path ways, work
tasks.
lists, including discharge planning
Advantages in Utilizing Nis5
• uses computer applications to enter client data
1. Increased observation due to forced recall
(demographic, vital signs, physiological data)
2. Increased Accuracy and reliability of observations
• uses information management systems for client
3. legibility with less time required to read and interpret
education
accurately
• uses technology based client monitoring systems
4. Decrease time in writing notes
• operates peripheral devices (bedside and hand held)
5. Available for statistical analysis. Elements already coded
• automatic billing while nursing documentation
can be selected.
• uses e-mail systems to communicate
6. Teaching tool to guide [Link] develop
• Uses presentation applications to create slides, displays,
elements to help staff with what they need to look for
overheads (PowerPoint, Corel Presentation, etc.)
7. Errors and omissions are decreased or eliminated with
• participates in the design and develop design and
protocol followed

Keywords: Clinical Information System, Virtual reality, 20

Ubiquitous computing - R. Ponchitra
 NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

development of new applications for nursing practice and actions

• participates in developing new methods for data and • Online registration, scheduling, attendance tracking,
information organization test administration and grade management of courses
• upholds ethical standards related to data security, through learning management systems
confidentiality and clients' right to privacy
• Remote access to libraries or online publications
Nursing Administration : • Web based Education
• Workload measurement systems that collect statistics
Nursing Research
for internal and external reporting requirements
a. Problem identification and literature review
• Indenting and stocking
• Search databases for current research
• Online computer policy, protocols and procedure
• Availability of full text journal articles
manuals that guide organizational practices
• Research design
• Staff scheduling systems that either automate
schedules or allow for self-scheduling through rules- • Search the literature for instruments
based protocols • Design and test instruments
• Internal email and/or systems for improved b. Data collection and analysis
communication
• Create forms for data collection
• Cost analysis of specific patient populations
• Calculate descriptive and analytic statistics
• participates in design of data collection tools for practice
• Display output in tables, charts, lists, and other easily
decision making and record keeping
read formats
• participates in quality management initiatives related to
patient and nursing data in practice c. Research dissemination

• participates in patient instructional program • Word processing programs used to author the final
development reports

• Trending & forecasting • Send the reports to various readerships

• Safety and quality • Frequently used to present research at meetings

• Make judgments based on data trends and pattern d. Grants

? participates in ergonomic design of work stations, bed • Locate
side access stations and portable apparatus equipment
• Download and submit funding applications
• uses decision support systems, expert systems and
other aids for clinical decision making and care planning Nurse Informatics Role1
• User liaison- involved in installation of a CIS and
Nursing Education
interfaces with system vendors, the users and
• Presentation software
management of health care institution
• Computer labs or resource centers
• Project manager- planning and implementing
• Computer assisted Instruction informatics project
• teleconferencing • Educator- develops and implements educational
• Simulation labs with lifelike mannequins that mimic real materials and educational sessions about system to
patient scenarios and respond to nurses' interventions employees

Keywords: Clinical Information System, Virtual reality, 21

Ubiquitous computing - R. Ponchitra
 NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

• Product developer-participate in design, production • Measurement of performance against standards of

and marketing of new informatics solutions practice to identify systems issues and opportunities for
• Decision support/outcomes manager- use tools to improvement
maintain data integrity and reliability
Decision Support
• Systems analyst- serves as link between nursing and
• Cues and information built into the system to assist in
information services
making care decisions
• Consultant- provide expert advice, opinions and
recommendations based on her area of experience Data Management

• Advocate/policy developer- develop the infrastructure • Workload statistics

of health policy • Performance monitoring
• Entrepreneur- analyzes nursing information needs and • Performance improvement projects
develops market solutions • Identification of problem areas
• Researcher- conduct research to create new informatics • Before and after data
knowledge • Regulatory compliance
• Chief information officer-provides leadership and
Issues Related to Computers In Nursing7
management at the executive level for both the
organization and the vendors 1. Legal/Ethical Issues

• Web developer-Web development responsibilities • privacy/confidentiality

• Programmer-ability to code identified specifications for • access to data for research and other purposes
system development, enhancement or issue resolution • informed consent
• Net work administrator-ensures networks continuously • License issues with telenursing
runs smoothly • Copy right of materials on the Web

Benefits of Information Technology in Healthcare10 2. Ergonomics

Safety - Computer technologies can place safety barriers Most common injuries- muscle and eye strain
within high risk processes to improve patient safety
Guidelines and Strategies to Minimize Risk4
Efficiency -
1. Never give out your computer password
• Achieved through the use of computers and computer
2. Always log off when you leave a computer terminal
technology as a data management tool
3. Follow procedures for correcting mistakes before
• Moving away from paper records – improves access to
computer entries are permanent
the data you need without flipping through a bulky
4. Don't leave patient information displayed on a screen,
patient record
keep track of printed information and dispose of it
• Easier retrieval of data associated with a particular
properly
process
5. Follow institutions confidentiality policies and
• Data sharing is improved between disciplines
procedure
Quality Improvement
Informatics Attitudes10
• Allows for auditing to assure a consistent standard of
• Appreciate the necessity for all health professionals to
care
seek lifelong, continuous learning of information

Keywords: Clinical Information System, Virtual reality, 22

Ubiquitous computing - R. Ponchitra
 NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

technology skills leader in informatics will most certainly be integral to the

• Value technologies that support clinical decision- industry's future.
making, error prevention, and care coordination
Strategic Directions for Nursing Informatics Future10
• Protect confidentiality of protected health information
• Include informatics in nursing education
in electronic health records
• Prepare nurses with specialized informatics skills
Value nurse's involvement in the design, selection and
• Enhance nursing practice and education through
implementation of information systems
informatics projects
12
Building A New Future • Increase nursing faculty preparation in informatics
Healthcare organizations can do much to support the • Encourage collaboration
evolving role of nursing informatics.
Emerging Technologies to Improve Nursing Practice
• Develop nurses' potential to fulfill emerging informatics
management roles by focusing on leadership skills such 1. Wireless communication

as communications, strategic and systems thinking, 2. Real time location system

clinical, financial and business operations, and technical 3. Delivery robots
skills. 4. Work flow management systems
• Build a culture that supports nursing informatics 5. Wireless patient monitoring
through programs organized around reward and 6. eMAR with Bar coding
recognition, professional development, mentoring,
7. Clinical documentation
performance planning and assessment, and career path
8. Interactive Patient system
development.
• Conduct research and explore new models focusing on Conclusion :
the roles, responsibilities, competencies of chief DREAM, DARE, AIM to be an INNOVATOR. The nursing
medical information officers (CMIOs), chief nursing profession has a strong commitment to the specialty of
informatics officers (CNIOs) and CNOs, as well as the nursing informatics. The demand for professional nurses
function and scope of relationships with other members with informatics backgrounds will likely continue to rise
of the C-suite: CIOs, CEOs, CMOs, CFOs and CTOs. .The demand for Clinical IT leadership has provided new
Explore new models that also create a strong tie roles and opportunities for nurses in all areas of healthcare.
between informatics and professional practice and Many of the reasons why nurses are being sought for IT
interdisciplinary practice. leadership positions are based on fundamental skills
• Develop and champion leaders with the ability to unique to their profession including being knowledge
develop, deploy, re-engineer and integrate clinical experts in the clinical care process, global systems view,
information systems; function as members of strategic ability to manage large projects or staff, and understanding
management teams; and collaborate on goals and the need to access patient information. This is the time to
implementation of clinical information systems. move forward, if you are a nurse seeking advancement in

As the healthcare landscape continues to shift, nurses are healthcare information technology. Now is the time to

key leaders to navigate the need for coordinated care and craft a successful career path in nursing informatics. Keep

enable better data infrastructure. The role of the nurse abreast of “latest greatest” technology trends.

Keywords: Clinical Information System, Virtual reality, 23

Ubiquitous computing - R. Ponchitra
 NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110

Nitte University Journal of Health Science

References :
1. MC Gonigle. Nursing Informatics .1st Edition. New Delhi: Jones and 8. Nursing Roles in Informatics - Philadelphia University
Barlet India Pvt. Ltd; 2010 [Link]/academics/rabia_allari/.../informatics.
2. Clark .creative Nursing Leadership & Managmenet. 1st Edition. New 9. Brian Mongrain NURS 457 Trends in Nursing Informatics -
Delhi: Jones and Barlet India Pvt. Ltd; 2010 [Link]/.../nurs-457-trends-in-nursing-in... - United
3. Cherry. Barbara, Jacob. R. Contemporary Nursing 3rd [Link]: States
ELSEVIER MOSBY; 2002 10. Evolution of Nursing Informatics Role, VHA eHealth University 2010 ...
4. [Link] .Management an dLeadership for Nurse administrators, [Link]/vehu2010/ppt/222_NUR.pptx - United States
5th edition. New Delhi: Jones and Barlet India [Link].2010 11. RUTH H. SCHLEYER Defining and Integrating Informatics
5. [Link] .Advanced Practice Nursing. 1st edition . New Delhi: Competencies Into a Hospital Nursing Department
Jones and Barlet India [Link].2010 [Link]
6. Ann shepherd. Nursing Informatics - Iowa Chapter HIMSS 12. Michelle Troseth, Informatics & the Future of Nursing Practice
[Link]/pubs/NursingInformaticsPastPresentFuture. [Link]
7. Nursing Informatics - Oakton Community College [Link] [Link]
/user/~mikey/[Link]

Keywords: Clinical Information System, Virtual reality, 24

Ubiquitous computing - R. Ponchitra