BACHELOR OF SCIENCE IN NURSING:

NURSING INFORMATICS
COURSE MODULE COURSE UNIT WEEK
1 1 1

Historical Perspectives of Nursing and the Computer

Read course and unit objectives

Read study guide prior to class attendance
Read required learning resources; refer to unit
terminologies for jargons
Proactively participate in classroom discussions
Participate in weekly discussion board (Canvas)
Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Define Nursing Informatics (NI), Clinical Information Systems (CIS) and other terminologies
related to the study of Nursing Informatics
2. Track historical foundation of computers in practice of the nursing profession as to:
a. Six Time Periods
b. Four Major Nursing Areas
c. Standards Initiatives
d. Significant Landmark Events
 3. Identify international institutions dedicated to the improvement of Nursing Informatics in a
global perspective
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly and graciously.
4. Develop heightened interest in studying Nursing Informatics

Psychomotor:
1. Participate actively during class discussions and group activities
2. Express opinion and thoughts in front of the class

Saba, V., and McCormick, K. (2006) Essentials of Nursing Informatics 4 th Edition, Overview of
Computers and Nursing, Historical Perspectives of Nursing and Computer (pp 3-15). New York:
McGraw-Hill Companies

“Computers and Nursing” by Jeff Zipparo

Computers have helped nearly every industry, electronic based or not, to better serve themselves,
and their clients; largely through software programs that allow industries to streamline complex
business-related data and that permit better communication between employers, employees, and
clients. Without a doubt, computers have a strong place in our society and will continue to affect the
way in which businesses conduct themselves, including the medical industry.

One example of computers in the medical field is bedside monitor devices. These computers are
helping advance medical care to a level of quality formerly unimaginable. Computers are, and will
continue to allow nurses to access, record, and monitor patient records, as well as, find in depth
research related to their patient within seconds. This is a vast improvement to the hours it may have
taken in the past. “Because of this time reduction, nurses are able to have more direct client care”
(Ricketts, 2003).

The increase in direct patient care allows for a better nurse-patient relationship, thus letting the nurse
truly affect the wellbeing of the patient. A nurse acting in the educator role, and with a computer, will
no longer be limited to handwritten self-care directions or black and white sketches. Nurses will be
able to access video clips, diagrams, and detailed pictures to help the patient on the road to recovery.
Furthermore, with the guidance of a nurse a patient will be able to “access support groups, medical
facilities, and health care providers,” thus “empowering clients to assume an active role in their health
care” (Ricketts, 2003).

Computers will also be able to help nurses on a personal level. There are a host of online courses
that a nurse can take which will allow better patient care, as well as, opening the door to new job
opportunities and job advancements for the nurse. Additionally, the internet allows nurses to search
for careers around the world, and even research employers to find the best possible match. The
internet also allows nurses to keep in touch with each other through forums and news groups. These
online discussion areas “provide nurses with a method of exchanging immediate information and
discussing nurse-related issues with colleagues throughout the world.” (Ricketts, 2003).

The ultimate goal of the medical-computer relationship is to one day allow client records to be viewed
by experts across the world via the internet, and to have vital information immediately sent to the
bedside nurse in order to provide the best possible care to the client. However, moving from the
“hard copy” age to the computer age does have risks. One such risk is the hacking of client records,
which poses a major risk to the privacy of patients. Another risk is the loss of entire client data bases
due to software viruses or hardware failure. Finally, in the event of large-scale power problems the
medical staff could be without pertinent patient information for extended periods of time, which would
greatly hamper patient care.

Nonetheless, I believe computers to be a necessary part of the medical community. From the
simplest PDA program to the most complex electronic surgical monitoring device, computers have
found a niche in medicine that is only adding to the success of medical procedures. As the computer
raised generations slowly enter the medical field, the symbiotic relationship between computers and
professionals is one of incredible potential.

Major Historical Perspectives of Nursing and Computers

Computer technology emerged in nursing in response to the changing and developing

technologies in the healthcare industry and in nursing practice. The major historical perspectives of
nursing and computers can be analyzed based on the following themes:
• Six time periods (divided on time coverage prior to 1960s to post 2000)
• Four major nursing areas (nursing practice, administration, education and research)
• Standards initiatives (nursing practice, data, healthcare data standards)
• Significant landmark events (chart)

Six Time Periods

Six historical perspectives of nursing and computers are as follows:

Prior to 1960s - Simple Beginnings

The use of computers in both computer and medical industry grew on early 1950s. There were
only few experts who formed a cadre of pioneers that attempted to adapt computers to healthcare
and nursing. During this time, the image of nursing profession is undergoing major changes:
improving nursing image, expansion of scope and complexity of nursing practice and services and
the increasing number of new nurses. Initially, computers were used in health care facilities for
basic business office transactions. Some examples are punch cards to store data and card readers
for computer programs, sorting and preparation of data for processing. They were linked together
and operated by paper tape and used teletypewriters to print their output. As computer technology
advanced, healthcare technologies improved.

1960s - Issues and NI Researches

The use of computer technology in healthcare settings began to be questioned. Areas of debate
are centered on the application of computers and data that needs to be computerized. Nursing
standards were reviewed and resources were analyzed. Studies were conducted to assess
computer technology and its effective utilization in the healthcare industry. Nurses’ stations were
considered as “hub” of information exchange.

The increasing number of healthcare facilities was paralleled to the advancement in computer
technology. The introduction of new computer technologies such as the Cathode Ray Tubes (CRT)
added more dimensions to computer systems providing more accessible and user-friendly
machines.

Hospital Information Systems (HISs) were primarily developed to process financial transactions but
few emerged to document and process healthcare activities.

Computer vendors were beginning to penetrate the healthcare field but the progress was slow due
to limitations in technology, lack of standardization and diversity in paper-based patient records.

1970s - Giant Leap for NI

Nurses begin to recognize the value of the computer for their profession. Giant steps were taken in
both nursing and computer technology. Nurses assisted in the design of HISs and other
environment that lead to the development of forerunning software as bases of today’s systems.
Computer applications for financial and management functions of patient care systems were
perceived as cost-saving technologies. Several states and large community health agencies in the
US developed and/or contracted for their own computer-based Management Information Systems
(MISs) which provide statistical and financial information required local government and federal
agencies for specific program funds and reimbursement of patient services such as Medicare,
Medicaid and other third-party payers.
1980s - Emergence of Informatics Field

The field of Informatics emerged in the healthcare industry and nursing. NI became an accepted
specialty and many nursing experts entered the field. Technology challenged creative
professionals and the use of computers in nursing became revolutionary. The need for nursing
software evolved and nursing education identified the need to update practice standards,
determine data standards, vocabularies and classification schemes that could be coded for
Computer-based Patient Record Systems (CPRSs).

Many mainframe HISs emerged with nursing subsystems that documented several aspects of the
patient record including Kardex, results reporting, vital signs and other system that documented
narrative nursing notes via word-processing packages. Discharge planning systems were also
developed and used as referrals to community healthcare facilities in the continuum of care.

The microcomputer, widely known as the personal computer (PCs) emerged that made
computers more accessible, affordable and usable by nurses. It served not only terminals linked to
mainframe PCs but also as stand-alone systems or workstations.

1990s - Affirmation of Nursing Informatics as Specialty Field

Computer technology became an integral part of healthcare settings, nursing practice and nursing
profession. Professional organizations identified initiatives that addressed IT and informatics.
Policies and legislation were adopted promoting computer technology in healthcare including
nursing.

The nursing profession became actively involved in promoting NI. NI was approved by American
Nurses Association (ANA) as a new nursing specialty.

The need for computer-based nursing practice standards, data standards, nursing minimum data
sets and national databases emerged concurrent with the need for a unified nursing language
including nomenclatures, vocabularies, taxonomies and classification schemes. Nurse
administrators demanded that HISs should include nursing protocols and nurse educators
continued to require use of innovative technologies for all levels and types of nursing and patient
education. Nurse researchers required knowledge presentation, decision support, and expert
systems based on aggregated data.

The 1990s bring about development of smaller and faster computers – laptops and notebooks,
workstations, Local Area Network (LANs) and Wide Area Networks (WANs). The internet made it
possible for the information and knowledge databases to be integrated into bedside systems.
The internet brought new cyberspace tools. By 1995, the internet introduces electronic mail (e-
mail), file transfer protocol (FTP), Gopher, Telnet and WWW protocols. The Web became the
means for communicating online services and resources.

Post 2000 - Rapid Growth and Development in NI

Healthcare and nursing undergone developments such as wireless point of care, open source
solutions, regional database projects and increased IT solutions on healthcare environment.
Clinical information systems became individualized in the Electronic Patient Record (EPR) and
patient specific systems considered for the lifelong longitudinal record or the Electronic Health
Record (EHR). Mobile computing devices were also introduced such as Personal Digital Assistants
(PDAs), Tablet computers and smart phones. The Voice over Internet Protocol (VoIP) promises to
provide cheap voice communication for healthcare organizations. The prediction of smart cards
was realized in Europe (Germany).

The internet has provided a means for development of clinical applications. Critical care units are
monitored remotely by health providers. Telenursing, a recognized specialty since the late 1990s,
is increasing in popularity and providing patient care in an efficient and expeditious fashion

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted post
year 2000 to streamline health care transactions and reduce cost. Standardized transaction and
code sets were implemented in early 2004 to protect security and ensure privacy and
confidentiality of healthcare data. The legislation recommended healthcare providers to use
Provider Identification Number (PIN).

Four Major Nursing Areas

The historical perspectives on nursing that shaped the need for computers, information
technologies and informatics can be describe through focusing on major areas in nursing

Nursing Practice

Nursing practice has evolved and changed radically. It has become an integral part of the EHR.
Computer systems with nursing, and patient care data, nursing care plans are no longer separate
subsystems of the computerized HISs, but rather integrated into one interdisciplinary patient health
record in the EHR. The need for an interdisciplinary EHR resulted because of the many initiatives
proposed and promoted by the nursing profession as well as by the other health care providers.
They all require patient care data to track the care process. Further nursing practice data emerged
with the introduction of several nursing terminologies that were recognized by the ANA as coded
terminologies usable for the EHR. They are used to assess problems, document care, and track the
care process, and measure outcomes. Thus, the electronic version of nursing practice – the
computer – has revolutionized and transformed nursing practice.
Nursing Administration

Nursing administration in hospitals has also changed with the introduction of the computer that links
nursing departments together. Most hospital policies and procedure manuals are accessed and
retrieved by computers. Furthermore, work load measures, acuity systems and other nursing
department systems are online and integrated with the hospital or patient’s EHR system or in
separate nursing department systems. The internet is being used by nurses to access digital
libraries, online resources, and research protocols at the bedside.

Nursing Education

The computer has radically changed nursing education. Most universities and schools of nursing
offer computer-enhanced courses, online courses (open university), and/or distance education.
Campus wide computer systems are available for students to communicate via e-mail, transfer data
files, access digital libraries, and retrieve online resources of millions of Internet sites. An email
accounts is considered a gateway to these possibilities.

New educational strategies require different methods of teaching. The advent of computers in
educational technology has greatly revolutionized teaching methodologies and strategies. Today,
most faculty members use the Internet to teach courses via the Web and communicate with other
students via email. The students on the other hand have to be more active and assume more
responsibility for their education that can be enhanced through the use of the Web. The WWW
facilitates student-centered instructional settings creating a motivating and active learning
environment. Finally, time, distance and cost are no longer barriers to educational programs.

Nursing Research

Nursing research provides the impetus to use the computer for analyzing computer data. Software
programs are available for processing both quantitative and qualitative research data. With the
advancement of computer technology databases supporting nursing research emerged, principally
for online searching and retrieving information from the electronic bibliographic information systems
or other databases that contain relevant healthcare content, such as drug data. The internet also
provides online access to millions of Web resources around the world which have increased the
capabilities and expanded the field of nursing research

Standard Initiatives

The third significant historical perspective concerns standard initiatives focusing on nursing
practice standards, nursing data standards and healthcare data standards as well as federal
legislation that impact on the use of the computer into nursing:
Nursing Practice Standards

There are two professional organizations that pioneered the setting of standards in the nursing
practice:
• American Nurses Association (ANA) - is considered as the official nursing
organization that contributes in the development and recommendation of standards of
nursing practice worldwide. In 1998, the ANA published the Standards of Clinical
Nursing Practice which focused not only on the organizing principles of clinical nursing
practice but also the standards of professional performance. They also recommend that
the nursing process serve as the conceptual framework for the documentation of
nursing practice.d
• Joint Commission on Accreditation of Hospital Organizations (JCAHO) - focuses
on the need for adequate records on patients in hospitals and practice of standards for
the documentation of care by nurses. They also recommended acuity systems to
determine resource use as well as required care plans for documenting nursing care.
JCAHO described the required contents of an EHR (example: collection and
organization of electronic data) though the publication of their recent manual.

In the Philippines, standardization of the nursing profession was instigated by the Philippine
Nurses Association (PNA), as a member of the International Council of Nurses, founded way
back September 2, 1922 and the Board of Nursing which was empowered by the Republic Act
9173.

Nursing Data Standards

Nursing data standards has emerged as a new requirement for the EHR. There are 13 nursing
terminologies that have been recognized by ANA such as the Critical Care Classification (CCC),
Nursing Outcomes Classification (NOC) and Nursing Information Classification (NIC).

The ANA is the worldwide organization responsible for the recognition of the terminologies in
nursing education. Other organizations that contribute to the standardization of nursing data are as
follows:

• American Society for Testing and Materials (ASTM) – The ASTM facilitates student-
centered instructional settings creating a motivating and active learning environment
• High Level Seven (HL7) – Health Level Seven is one of several American National
Standards Institute (ANSI) - accredited Standards Developing Organizations (SDOs)
operating in the healthcare arena. Most SDOs produce standards (sometimes called
specifications or protocols) for a particular healthcare domain such as pharmacy,
medical devices, imaging or insurance (claims processing) transactions.
• International Health Terminology Standards Development Organization (IHTSDO)
– is a not-for-profit association that develops and promotes use of SNOMED CT to
 support safe and effective health information exchange. SNOMED CT is a clinical
terminology and is considered to be the most comprehensive, multilingual healthcare
terminology in the world.
• National Committee on Vital and Health Statistics (NCVHS) – a statutory public
advisory body to the Secretary of Health and Human Services (HHS) that has a 57 year
history of advising HHS in the areas of health data, health statistics, privacy and national
health information policy. The members are leaders and experts in their fields, and the
NCVHS has a reputation for open, collaborative processes and ability to deliver timely,
thoughtful, and practical recommendations.

Significant Landmark Events

Shown in the following table are the highlights in the history of nursing informatics:

YEAR EVENT
1961 Healthcare Information and Management Systems Society (HIMSS) is founded
Development of one of the first Hospital Information System (HIS) at El Camino Hospital in
1965
Mountain View California
First Invitation conference on Management Information Systems (MIS) for public/ community
1973
health agencies, held in Fairfax Virginia
First research: state-of-the-art conference on Nursing Information Systems (NIS) held in
1977
Chicago
1979 First military conference on computers in nursing in Washington DC
1980 First workshop on computer usage in healthcare sponsored by the University of Akron Ohio
First national conference on computer technology and nursing held in Bethesda, MD
1981
Nursing Information Systems Journal first published
First National Nursing Computer Technology Conference, becoming an annual event, held
in Newark, New Jersey
1982 First international meeting: Working Conference on Nursing Uses and Computers in Nursing
held in London
First workshop on computers in nursing held in Boston
First nursing computer journal is published: Computers in Nursing
1984 Counsel in Computer Applications in Nursing (CCAN) formed in Kansan City
First Nursing Minimum Data Set (NMDS) meeting
Council on Nursing Informatics formed in New York
First invitational NMDS conference held
1985 Essentials of Computer Electives initiated in graduate and undergraduate programs at
Georgetown University School of nursing
American Nurses Association recognizes NANDA as the first taxonomy in nursing
Graduate program in Nursing Informatics introduced at Maryland University in Baltimore and
1989
University of Utah
1990 ANA Congress of Nursing Practice recognizes Nursing Informatics as a specialty area
1991 International Classification of Nursing Practice (ICNP) was initiated
 First Doctoral Specialty in Nursing Informatics sponsored by Maryland University
American Nursing Informatics Association is initiated at California, has since become
international
1992
ANA recognizes taxonomies
ANA recognizes Nursing Informatics as a specialty by delineating the scope of practice
1993 Electronic Library goes online
First International Nursing Informatics, Teleconference held in Melbourne, Australia,
Auckland and New Zealand
1995
Credentialing in Nursing Informatics initiated by American Nurses Credentialing Center
(ANCC)
First Harriet Werley Award for best nursing informatics paper
1996
Online Journal of Nursing Informatics (OJNI) first published
Nursing Information and Data Set Evaluation Center (NIDSEC) standards and scoring
1997
guidelines published to address documentation of nursing care
1999 Nursing Vocabulary Summit Conference Held
Canadian Informatics Nurses Association received emerging group status from the
2001
Canadian Nurses Association
JCAHO identified clinical information systems as a way to improve safety and recommended
2002 that hospitals adopt technologies
Online MSN in Nursing Informatics offered by Duke University
HIPAA deadline for electronic transaction standards enacted in October
2003
President calls for widespread adaptation of Electronic Health Record (EHR) in 10 years
2004 The office of the National Health Information Coordinator established

Computer – it is a general term referring to Information Technology (IT) and computer systems. In
nursing, it is synonymous to Nursing Information Systems (NIS), nursing computer applications
and Nursing Informatics (NI). Computers are used to manage information in patient care, monitor
quality of nursing care and evaluate care outcomes. Computers with networks are now used in
communicating data via the internet, accessing resources and interacting with patients on the
World Wide Web (WWW).

Nursing Informatics – it refers to the integration, of nursing, its information and information
management with information processing and information technology to support the health of the
people worldwide (International Medical Informatics Association, 1998). It is a specialty that
integrates nursing, computer and information science to manage and communicate data,
information and knowledge in nursing practice. It 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, processes and
information technology (American Nurses Association, 2006).
Clinical Information Systems – this can be used interchangeably with Electronic Health
Information Systems (EHR-S), computerized patient record and electronic medical record. It refers
to a set of components that form the mechanism by which patient records are created, used,
stored and retrieved and usually located within a healthcare provider setting. It includes people,
data, rules and procedures, processing and storage devices, communication and support facilities
(Institute of Medicine, 1991).

Goodwin, L. 2004. A Brief History of Nursing Informatics, Lecture notes on Issues of Nursing
Informatics, 2004, Durham, Duke University School of Nursing.

Simpson, R. L. (2003). Nursing Informatics. The Role of IT in Health Care Quality Assessment.
Nursing Administration Quarterly, 27(4):355-9.

Study Questions

• Choose among the “Six Time Periods” in the historical perspective of computers in nursing that
is worth receiving the title the “Golden Age in Nursing Informatics”. Write the rationale in essay
form (word count 80-100).
• Submit an organizational profile of an international institution dedicated to the improvement of
Nursing Informatics.
• Download a research article on the topic ‘Nursing Informatics’ from ScienceDirect. Submit a
200-300-word essay reflection.

Garo, C. (2004) Teaching Educational Technology. Mandaluyong City: National Bookstore Inc.

IHTSDO (2008), Welcome to IHTSDO. Retrieved August 25, 2020 from International Health
Terminology Standards Development Organization, Website: http://www.ihtsdo.org/
McCaslin, K. (2008), What is HL7?. Retrieved August 25, 2020 from Health Level Seven, Website:
http://www.hl7.org/

McGonigle, D., Seymour, R., Englebardt, S., Allen, M., Chang, B. (2001). The Online Journal of
Nursing Informatics (OJNI). Online Journal of Issues in Nursing. Vol. 5, No. 1, Manuscript 6d
Saba, V., and McCormick, K. (2006) Essentials of Nursing
Informatics 4th Edition, Overview of Computers and Nursing,
Historical Perspectives of Nursing and Computer (pp 3-15).
New York: McGraw-Hill Companies

Staggers, N., Thompson, C. B., & Snyder-Halpern, R.

(2001). History and Trends in Clinical Information Systems
in the United States. Journal of Nursing Scholarship,
33(1):75-81.

Zipparo, J. Computers in Nursing. Retrieved August 25,

2020 from Student Work Zone, Website:
http://www.studentworkzone.com/question.php?ID=69