INFORMATION AND KNOWLEDGE NEEDS OF NURSES IN THE 21STCENTURY 9

KEY TERMS DEFINED

•Clinical information system (CIS) - Array or collection of applications and functionality;
amalgamation of systems, medical equipment, and technologies working together that are committed or
dedicated to collecting, storing and manipulating healthcare data and information and providing secure
access to inter-disciplinary clinicians navigating the continuum of client care; designed to collect patient
data in real time to enhance care by providing data at the clinician's fingertips and enabling decision
making where it needs to occur, at the bedside; also known as clinical documentation systems.
•Clinical decision support (CDS) -A computer based program designed to assist clinicians in making
clinical decisions by filtering or integrating vast amounts of information, and providing suggestions for
clinical intervention. May also be called a clinical decision support system (CDSS) .
•Evidence-based practice (EBP) – Nursing practice that is informed by research generated evidence of
best practices.•"The conscientious, explicit and judicious use of theory-derived, research-based
information in making decisions about care delivery to individuals or groups of patients and in
consideration of individual needs and preferences” (Ingersoll, 2000, p. 152); integration of clinical
expertise and best practices based on systematic research to enhance decision-making and improve patient
care; "evidence-based nursing is the process by which nurses make clinical decisions using the best
available research evidence, their clinical expertise, and patient preferences. Three areas of research
competence are: interpreting and using research, evaluating practice, and conducting research” (Simpson,
2004, p. 10).
•Nursing informatics (NI) - A specialty that integrates nursing science, computer science, and
information science to manage and communicate data, information, knowledge and wisdom 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; “a specialty that integrates nursing science, computer science, and information science to
manage and communicate data, information, and knowledge” (Staggers & Thompson, 2002, p. 260);
synthesis of nursing science, information science, computer science and cognitive science to facilitate the
management of healthcare data for the improvement of patient care and advancement of the nursing
profession.
•Nursing knowledge -A body of facts accumulated over time from experience, education, and research
that are used to make nursing decisions. •“simultaneously the laws and relationships that exist between
the elements that describe the phenomena of concern in nursing (factual knowledge) and the laws or rules
that the nurse uses to combine the facts to make clinical nursing decisions” (Graves & Corcoran, 1989, p.
230).
•Research utilization (RU) - The process of moving new understandings generated in research into
practice.
INTRODUCTION
•The information and knowledge informing 21stcentury of healthcare delivery has been growing at an
unprecedented pace in recent years. •Extended and expanded access to clinical research findings and
decision support tools has been significantly influenced by the advent of computerization and the internet.
 WOrking in environments of increasingly complex clinical care and contending with the management
of large volumes of information, nurses need to avail themselves of the technological tools that can
support quality practice that is optimally safe, informed and knowledge-based.
•This chapter will address the goals of informatics as it relates to nursing and more specifically address
the benefits to be derived from the integration of information and communication technologies into
practice settings.
•The relevance of informatics to support and advance the practice and knowledge of all nurses will be
discussed in the context of today’s healthcare delivery settings. •Finally, the author will provide a
contemplative view of the future for nurses and informatics.
INFORMATICS DEFINED
•While varied and evolving over the years, the most commonly applied definitions of nursing informatics
describe it as the intersection of computer, information, and nursing science (Graves and Corcoran, 1989;
Staggers & Thompson, 2002).
•Nurses in identified informatics roles typically focus their efforts on:
o articulating meaningful clinical nursing data and information structures that can be codified and
processed
o identifying the information processes associated with nurses’ work
o determining ways in which information and communication technologies can be most effectively
utilized to support the capture, retrieval, and use of data, information, and knowledge.
THE GOAL OF INFORMATICS
•Although already in use for a number of decades, the term “informatics” is typically viewed by the
broader nursing community as the use of computers by nurses. •There are some nurse authors beginning
to de-emphasize the notion of “nursing informatics” and discussing the role of nurses and their work
processes in the context of “health informatics” (Hannah, 1995).
•Health informatics has been described as “knowledge of health services delivery, technology,
applications, information, methodologies, and data management processes” (Kathryn Hannah cited in
Thede, 2006).
•The umbrella of “health” informatics suggests that the informatics work being done by nurses must fit
within the context of the “whole system”.
•More timely access to data and information, clinical and financial, has been identified as a necessity in
the climate of 21st century healthcare delivery (Hannah, 1995).
•Health service organizations, societies, and governments throughout the industrialized world are
obsessed with assuring that healthcare delivery is: •safer•knowledge-based•cost-effective
•seamless•timely
•An additional challenge within the nursing profession is the pending human resource crisis and dire
projections of imminent shortages.
•Nursing’s focus on IT has been elevated as a central means by which nurses can be sufficiently
supported in their work environments
. •IT has the potential to reduce the waste of valuable nursing resources by reducing the time spent in the
“care and feeding” of patient records. Having more time for direct client care that is supported by ready
access to information and knowledge translates into the provision of safer, quality care.
NURSE – KNOWLEDGE WORKER
•Nurses definitely fall into the category of knowledge workers. •Studies have identified that depending
upon the setting, nurses spend anywhere between 25-50% of their day managing and recording clinical
information and seeking knowledge to inform their practice (Gugerty et al, 2007).
•As the evidence to support nursing practice continues to be uncovered by researchers and integrated into
healthcare delivery, attention must be given to the tools that will afford ready and easy access to same.
•It could be suggested that as knowledge workers, nurses are also, albeit unwittingly, informaticians to a
large extent.
•With the advent of clinical information systems (CIS), specifically electronic documentation and clinical
decision support (CDS) applications, every nurse has the capacity to be contributing to the advancement
of nursing knowledge on many different levels
CREATING CLINICAL KNOWLEDGE
•Graves and Corcoran (1989) suggest that nursing knowledge is “simultaneously the laws and
relationships that exist between the elements that describe the phenomena of concern in nursing (factual
knowledge) and the laws or rules that the nurse uses to combine the facts to make clinical nursing
decisions” (p. 230).
•New technologies have made the capture of multi-faceted data and information possible through the use
of technologies like digital imaging (e.g., photography to support wound management).
•Now part of the clinical record, such images add a new dimension to the assessment, monitoring and
treatment of illness and the maintenance of wellness.
•These are but a few of the emerging capabilities that will allow for numerous data inputs to be
transposed -- combined, analyzed, and displayed to provide information and views of clinical situations
currently not possible in a world dominated by hard copy documentation.
•Many renowned nurse authors have described the knowledge used by nurses (Benner, 1983; Carper,
1978; Schultz & Meleis, 1988).
•Carper’s (1978) landmark paper on the “fundamental patterns of knowing” was the genesis of many
subsequent papers and analyses.
CREATING CLINICAL KNOWLEDGE
•Empirics – access to factual knowledge derived from repositories of aggregated clinical research
findings and integrated with the CIS.
•Esthetics – access to multicultural practices and beliefs.
•Personal – access to a personal repository of clinical experiences and reactions.
•Ethics – access to standards of ethical practice, but also access to experts in the field of moral reasoning
to guide interaction.
 •In each and every instance of interacting with the CIS, a nurse will add further to these repositories of
knowledge on the basis of their daily clinical challenges and queries.
•There will come a day when all nurses become generators of new knowledge by virtue of CIS that
embed “machine learning” and “case-based reasoning” methods within their core functionality. •Based
upon the evidence gathered through several studies, we are now aware of the potentially deleterious
effects of this practice.
USING CLINICAL KNOWLEDGE
•Evidence-based practice (EBP) and research utilization (RU) are concepts which have been widely
addressed in the nursing literature. •Best practice guidelines hold much promise for the future, but again
in their typical form of paper volumes and oft unsearchable online versions, these resources will not
realize significant adoption by an already stressed and stretched nursing workforce.
•The profession has been steadily moving towards consensus on the adoption of data standards and recent
work suggests that we are achieving significant strides (Bickford & Hunter, 2006; Delaney, 2006).
•Consider that as CIS are widely implemented, as standards for nursing documentation and reporting are
adopted, and as healthcare IT solutions continue to evolve, the potential to synthesize findings from a
variety of methods and world-views becomes much more probable.
CLINICAL DECISION SUPPORT
•Clinical decision support (CDS) tools have evolved beyond the previously prevailing notion of
accessible reference texts and written resource materials like policies and procedures. •Most available
clinical decision support (CDS) for nursing practice, although promising, are simplistic and in early
development.

CHALLENGES
•The field of nurse leaders in health informatics has markedly grown in the past two decades.
•For several years, nurse informaticians have advocated for the need for all nursing leaders to become
knowledgeable and engaged in setting the direction for informatics in the profession (Nagle, 2005;
Simpson, 2000).
•Identify the informatics education needs of nurse leaders.
•Develop mentorship programs for the acquisition of informatics leadership skills.
•Assure enrollment of nurse leaders as sponsors for electronic health records initiatives.
•Despite many valiant efforts to implement comprehensive CIS throughout North American healthcare
settings, there are still many provider organizations with limited online functionality available to nurses.
•Over the years, nurses have been on the receiving end of systems which either did not add value to their
work or by virtue of poor design, created additional work.
•The opportunity to avoid future installations of IT solutions that do nothing to benefit and support the
clinical practice of nurses and healthcare teams is upon us now.
•It behooves nurses to be engaged in the acquisition, design, implementation and evaluation of CIS to
assure the realization of benefits for clinical care and outcomes.
Nurses should:
•Be encouraged and supported to participate in the acquisition, design, implementation, and
evaluation phases of CIS.
•Demand the adoption of IT solutions that support the delivery of safe, quality care.
•Be provided with material and people resources to support their acquisition of informatics
competencies.
•Over the years, numerous efforts have been undertaken to identify the core informatics competencies
needed by nurses.
•In recognizing nursing informatics as a specialty, the American Nurses Association (2001) has
articulated “scope and standards of nursing informatics practice”. (2008 version is now available)
•Recent studies of schools of nursing indicate that few basic nursing education programs have embedded
the concepts and processes associated with informatics within the core curricula (Carty & Rosenfeld,
1998; Nagle & Clarke, 2004). •The core concepts and competencies of informatics are particularly well
suited to a model of inter-professional education.
•A presumption is often made that future graduates will be more computer literate than nurses currently in
practice. •Although likely true, computer comfort does not equate to an understanding of the facilitative
and transformative role that IT will have in the future.
A VIEW OF THE FUTURE
•Overall, it is fair to say that a majority of nurses have yet to embrace the notion of “informatics” and
understand its meaning and relevance to their work.
•The future holds a landscape yet to be understood as technology evolves with a rapidity and unfolding
that is rich with promise and potential peril.
•With the availability of such rich repositories, there will be opportunities to:
•Further enhance the training of health professionals;
•Advance the design and application of CDS;
•Deliver care that is informed by the most current evidence and
•Engage with individuals and families in ways yet unimagined.
•The future of healthcare will be highly dependent upon the use of CIS and CDS to achieve the systems’
global aspirations of safer, quality care for all citizens.
•The core concepts and competencies associated with informatics will be embedded in the practice of
every nurse, whether administrator, researcher, educator, or practitioner