RN's
"Nursing Informatics "
Nursing informatics is the vehicle that enables evidence of the effects of nursing interventions to be linked with the outcomes of care in relation to the problems identified for a specific patient or groups of patients (Swan et al., 2002). Nursing informatics addresses the management and processing of data, information, and knowledge to support nursing practice and the delivery of care (Bakken, Cimino, & Hripcsak, 2004; Delaney, 2001). Graves and Corcoran (1989) define nursing informatics as "a combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care" (p. 227). The Division of Nursing uses this same definition for nursing informatics and adds "...to deliver quality care to the public, particularly to disadvantaged and underserved populations" (National Advisory Council on Nurse Education and Practice, 1997, p. 7). The integration of computer science, information science, and nursing science requires a sustainable technology infrastructure to achieve nursing goals related to quality patient care.
Computer science or literacy refers to hardware, software, computing power and speed, interconnected networks, understanding of basic concepts, formal representation of evidence in computer-based systems, and the machinery used to access data and information systems. Information science refers to information retrieval, database searching, accessing unpublished studies, coordinating, utilizing, evaluating data and information systems, information management, hand searching, and direct communication with sources. Nursing science includes evidence, guidelines, research, knowledge generation, knowledge integration, decision making, and integration. Management of the outcomes of nursing care that contribute to nursing science is accomplished through the use of information systems, technology, and databases (Plocher & Wilson, 2002). Literacy in these areas of computer science and information science is a basic and fundamental requirement for nursing informatics competency.
Core informatics knowledge and computer skills are essential for all nurses to function effectively in the current health care environment (Carty & Phillip, 2001; Travis & Brennan, 1998). Basic computer skills are not the same as being computer literate in managing clinical and administrative information, which is essential for nurses to deliver quality care (Vanderbeek et al., 1994). What is also needed is the involvement of administrative and practicing nurses in the design and implementation of information systems. Often these systems are left to the informatics experts with little or no input from nurses. Even more distressing is that as health systems purchase information systems from vendors, no nursing executive is present at the table (Simpson, 2003).
As information systems are developed, the first inclusion has been administrative and financial data. The second wave of content has been physician orders and execution, and use of pharmaceuticals. Simultaneously, much development is underway for virtual use and documentation of radiology tests. Last and rarely included in the information technology priority list is nursing care, especially the nursing problems, interventions, and outcomes in a standardized format to be stored in administrative and clinical data repositories. This lack severely limits science/evidence-based practice, quality improvement activities, cost-effectiveness studies, and the use of the data for nursing research (Maas & Delaney. 2004); for example, nursing information and data set evaluation, integration of nomenclature, clinical content, and clinical data repositories. Technologic and informatics literacy are critical in the 21st century workplace.
Information technology has dramatically changed the way nurses work. It is clear that advances in technology and the Internet have transformed consumer and professional access to information and have influenced changes in public policy and the public's role in its health care. The public's expectations are presenting both challenges and opportunities for professionals and communities addressing health issues. Patients will identify more health information online and will take more responsibility for their care. Nurses and other health professionals will assist patients to assess the quality of information (Delaney, 2001; Kassirer, 2000; Stead, 1998; Stead & Lorenzi, 1999).
Using evidence and standardized nursing language embedded in information technology systems allows nurses and health care providers to act individually or collectively in performing a wide array of information creation and processing activities (Bakken & McArthur, 2001). Health organization information systems must provide the technology environment that enables nurses to use clinical information systems to access and synthesize information and evidence from a wide variety of sources, to evaluate the quality and importance of accessed information and evidence, to perform relevant manipulations of the information to describe best evidence, and to disseminate the results of their activities. In addition, the clinical data must be aggregated and stored in a data repository where it can be used for clinical research. When clinical data are added to administrative and financial data, cost effectiveness can be determined. As Simpson stated so well, "now more than ever, health care organizations need to understand the costs and how properly to assign resources to patients and they need to track outcomes — and few decision support systems can help them do that" (Simpson, personal communication, June 28, 2004). This process can be illustrated by the same continuous feedback loop Lang used to describe quality assurance.
It is vital to recognize the need for a paradigm shift in nursing that utilizes new informatics tools required for optimum use of evidence related to the delivery of quality nursing care. An example of these tools, predictive modeling, uses information about health status to predict future health care needs. Evidence is then used to translate that patient information to a predictor of health risks and outcomes (Celebi, 2003). Through the use of artificial intelligence, predictive modeling and evidence-based practice algorithms are being used for disease management (Solz, Liachenko, & Gilbert, 2002). Similar strategies must be developed and implemented for nursing management of patient problems.
The speed with which scientific nursing knowledge can not only be generated, but used to improve the quality of health care can be greatly accelerated by linking easily accessible computerized evidence to clinical information systems, and in turn capturing and storing the documented nursing data for new quality improvement and research studies. Informatics is the vehicle to facilitate this linkage. Embedding nursing language within informatics structures is essential to make the work of nurses visible, and articulate evidence about the quality and value of nursing in the care of patients, groups, and populations.
source: A preliminary version of this article was presented at the American Nurses' Association written by members of the American Academy of Ambulatory Care Nursing
"SUPER TWINS"WINSTON-SALEM, N.C. - They aren't America's heaviest newborn twins on record, but they certainly tip the scales: Sean William Maynard and Abigail Rose Maynard weighed in at a combined 23 pounds and 1 ounce at birth this week, a North Carolina hospital announced Friday.
Freda Springs, spokeswoman for Forsyth Medical Center, said the twins were delivered two minutes apart by Caesarean section on Tuesday at the center's Sara Lee Center for Women's Health in Winston-Salem.
The boy weighed 10 pounds, 14 ounces; the girl, 12 pounds, 3 ounces. Springs said both babies are in excellent condition after their birth to parents Joey and Erin Maynard of Winston-Salem.
The combined weight of the twins is about four pounds shy of the combined weight of twins born in Arkansas in 1927, the hospital said. Those twins weighed a total of 27 pounds, 12 ounces, hospital researchers said, adding they could find no public record of any heavier twins than the Arkansas pair born since 1900.
They said the Maynard twins topped a 1997 delivery in North Carolina of big twins weighing a total of 18 pounds, 10 ounces.
Sean, tucked in a blue blanket, was held by his mother and his sister, swaddled in pink, was cradled by her father at a hospital news conference Friday. The infants slept quietly through their first public appearance.
source: ASSOCIATED PRESS
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