data Ethics in Nursing Informatics Nursings long history includes primary concern for the patient or client and

commitment to the professional code of ethics for nurses. Therefore, the Code of Ethics for Nurses (ANA, 2001) serves as a framework for the informatics nurse specialist who faces ethical issues and ethical dilemmas. This concern for both the patient and commitment to the Code form the foundation for the informatics nurse specialists unique expertise and insight in this area. Although nurse the informatics not be quality

integrity

and

security, of appropriate

strategies adequate researcher,

during protection and

the of the

management and

review process to ensure the individual subject, the

information,

decision-making. More computing greater data powerful information new and and Health

technologies

permit approaches aggregation

organization? care professionals to adhering of to code the and are a

accustomed professional Others in management

linkage capabilities. But as these opportunities expand, the correct application of the methodologies needs continuing evaluation and monitoring. To ensure that appropriate informatics solutions are implemented, the informatics nurse specialist is instrumental in posing questions, such as: Has informed consent of the health care consumer been adequately secured? Are the databases from external appropriate protected Have

ethics.

information information

systems environments may not embrace such a tradition. Ethical questions or issues arise when common practices corporate run counter The business to the

ethical mandates of health care professionals. nurse to as: Is a code of ethics integrated into the expanding distributed environment of Internet health information and health care service delivery? What standards are in place to address concerns of interest about when conflict informatics brings the an specialist of

specialist

may

functioning as a clinician, the issues of confidentiality, security, and and privacy the surrounding associated the data, patient, clinician, and enterprise information, and knowledge are of paramount concern. These issues provide significant opportunities to the information nurse specialist for ethical analysis, decision making, and subsequent action. For example, the explosion of the human genetic mapping and testing technologies is creating valuable new insights into disease identification produces outcomes and treatment damaging same opportunities. However, this also potentially if that

integrated, systems perspective discussions ethical issues posed by such questions

and internal compromise? the retention and disposition policies been established? Are data information policies management enforced? Can client anonymity be maintained? Are technical, consultant, and vendor personnel for accountable

health information resources are posted as part of an organization or companys marketing strategy? Is the individual responding to the e-mail or Internet site query clinician truly a qualified appropriately

adherence to security and confidentiality mandates? Is the researcher for accountable

information is incorrectly reported or inadequately safeguarded and becomes available to the wrong person or agency. The informatics nurse specialist in this environment has a responsibility to advocate for confidentiality,

adherence to security and confidentiality mandates? Does Review include the database the Institutional (IRB) of and Board information

licensed to practice? Are appropriate safeguards in place to protect the senders identity content and and privacy, integrity the of

examination

management

messages,

and

the

miniaturization of technology is all evident. specialties is Consequently, and new partnering between nurses in

and nursing

communicate and practice. facilitates to and

data, in the support other Nursing

respondents identity?

information, informatics and

knowledge

The

Future

of

Nursing

Informatics After the Graves and Corcoran (1989) article, others proposed adding the concept of wisdom to the triad of data, information, and knowledge the (Nelson use and of Joos, data, in and 1989). Wisdom may be defined as appropriate and information, making knowledge

technologies imperative.

becoming

integration of data, information, knowledge nurses, patients,

Technological innovations are challenging many traditional processes within health care. Telecommunications technologies are one set of tools used in nursing practice. Core be competencies identified in the across near the among specialties will

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. The goal of NI is to improve the health of by populations, and and optimizing communities, individuals information families, management

decisions

informatics specialties should future. distinctions informatics continue to blur. The speed of information Therefore,

implementing nursing actions. It includes the ability to integrate data, information, and knowledge with professional values when human managing problems. Some nursing informatics (NI) experts believe strongly that wisdom is the purview of humans and cannot or should not be considered as a function within technology. Others believe that informatics with useful require to solutions expert consistent and will of professional the values nurses specific

communication. This includes the use of technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering in educational experiences,

transfer and the increasing availability of communications technologies specialists NI, in in will the impact future, more nurses and informatics nurse making nursing practice and particular, international in practice with worldwide standards, competencies, and curricula. This section outlined the scope of practice for informatics nurse specialists. In the next section, the standards of practice and professional addressed. INFORMATICS SPECIALIST PRACTICE Nursing informatics is the NURSE OF STANDARDS performance for informatics nurse specialists are

supporting life-long learning, and in supporting nursing research. The standards of practice for the informatics nurse specialist are organized around a general problem-solving framework that closely resembles the familiar of nursing process of assessment, diagnosis, outcomes, The problem-solving identification planning, framework

incorporation

wisdom. This controversy makes the inclusion of wisdom into the triad of data, information, and knowledge currently an unresolved issue within NI. This document represents the state the of field nursing of informatics. are are However, a number of trends in informatics and currently evident

implementation, and evaluation. supports all facets of informatics practice, including those without technology, nursing nurse and all areas of practice. specialists Informatics and method other to

mentioned here: Ubiquitous continued computing innovation is and

informaticians use a structured problem-solving identify and clarify issues and select, develop, implement, and

specialty that integrates nursing science, computer science, and information science to manage

becoming a reality and the

evaluate These

informatics

solutions.

include project management, implementation organizational database structures. methods, culture, and 2.

solution. Incorporates methods principles of such or and as issue

steps

are not mutually

exclusive and topics may overlap multiple identified steps. Informatics generic an term solution used in is a this

recognized

methodologies, into problem

2. and

Integrates (HCI)

ergonomics principles solution 3.

structured systems analysis, identification. Uses systematic methods to determine user and technical requirements for informatics issues. 4. Interprets the capabilities and limitations of legacy systems in integration planning and requirements determination. 5. Interprets current legislation, trends, and research affecting health management. 6. Actively participates in information

humancomputer informatics

document to describe the product informatics nurse specialist recommends after identifying and analyzing an issue. An informatics solution technology database, computer nursing may and encompass nontechnology a new

interaction into design, selection,

development, implementation,

and evaluation. 3. Systematically determines of an informatics

products such as developing a purchasing application, vocabulary, creating designing an a

the social, legal, and ethical impact solution within nursing and health care. Standard I. Identify the Issue or Problem The informatics nurse specialist synthesizes and data, information, to clarify knowledge

informatics curricula, creating a spreadsheet, application environment, research required competencies, information flow in study to tailoring a to designing particular describe informatics describing a process

informatics issues or problems. 7. Measurement Criteria The informatics nurse specialist: 1. Conducts a needs assessment to refine the issue or problem. a. Analyzes current practice, workflow, potential informatics and impact of solution the an on

strategic planning. Conducts a market analysis for an informatics solution. Standard II. Identify

redesign, or creating a structure for information presentation. Several standards aspect nurse of discussion practice. Overarching Standards of inherent practice of the overarching in every the of begin

Alternatives The informatics nurse specialist analyzes multiple approaches/ solutions to the informatics issue or problem. Measurement Criteria

informatics

specialist

standards

that workflow. b. Involves or c. problem crucial and its stakeholders in an issue informatics solution. Evaluates obtained information and findings for their pertinence to the informatics problem. d. Integrates current and future requirements into a vision for an informatics issue or

Practice for the Informatics Nurse Specialist The informatics nurse specialist: 1. Incorporates theories, into

The informatics nurse specialist: 1. Uses problem-solving approaches to informatics tools and issues

and processes to identify and evaluate solutions

principles, and concepts from appropriate informatics sciences practice.

and/or problems. These activities may include: a. Conducting analysis to a systems determine

Examples of theories could include information, systems, and change theories. Principles and concepts could

information needs. b. Developing functional and

technical based needs. c. Developing process

specifications upon identified

Standard

III.

Choose

and

8.

Actively

participates

in and

Develop a Solution The informatics nurse specialist

contract

development

negotiations, as appropriate. Standard IV. Implement the Solution The informatics nurse specialist manages the process for implementing the solution to the informatics issue or problem. Measurement Criteria The informatics nurse specialist: 1. Applies concepts principles of to of methods and project the the of the

business redesign

develops an informatics solution for a specific issue or problem. Measurement Criteria The informatics nurse specialist: 1. Interprets capabilities and of hardware of and

recommendations. d. Analyzing potential investment basis costs return (ROI) as and on a and

for selecting

limitations the

implementing informatics solutions. e. Judging the fit of the

software and their relationship to outcomes proposed in health informatics care. 2. Incorporates methods and in usability choosing, an solutions

proposed informatics solution with the strategic plan. 2. and issues Uses analytical to models to

management implementation solution. 2. Demonstrates when solution. 3. 4.

testing

identify and evaluate approaches solutions and/or informatics These problems.

developing

evaluating

informatics solution. 3. Analyzes to economic, support the

effective project management implementing

activities may include: a. Developing external, conceptual, and internal

technical, and human resources available informatics solution. 4. Incorporates established into the

Demonstrates expertise as a project manager. Designs effective informatics may include: a. strategies funding solutions, for of which

models for representing information needs. b. Designing models of

informatics

standards

informatics solutions. 3. Prepares documents to

informatics solution. 5. solution criteria targeted outcomes. Selects by an informatics selection for the expected

Developing a budget plan maintenance of an

describe information needs for the proposed informatics solution. These activities may include: a. Developing informal and formal as a requests for an for informatics solution such request information or an RFP. b. Preparing a response to a request for a proposed informatics solution. c. Using models to to key

applying and

for the procurement of resources and b. informatics solution. Determining priorities for within budget persuasive and political requirements constraints. c. Employing communication 5. and a. going

appropriate users

6.

Develops

an

evaluation

plan for the informatics solution including measurable outcomes and/or terminal objectives. 7. solution Develops an informatics such as designing a

astuteness in funding strategies. Develops policies, procedures, analytical findings, which the and of onan and guidelines based on research may include: Supporting use, maintenance implementation,

documentation tool, determining clinical vocabulary, tailoring an application environment, topic. to or a specific writing a

communicate stakeholders.

manuscript about an informatics

informatics solution.

b. c. safety d. e. f.

Ensuring the validity and Promoting within health the and

plan based on measurable, learner-oriented outcomes. b. Producing education based on e.

instruments to measure user satisfaction with the implemented solution. Identifying the extent to which the project budget and schedule are met. 2. Analyzes the impact of the solution and on families, institutions informatics

integrity of data. particular

materials c. d.

environment. Ensuring the use of an Ensuring the ethical use Ensuring and security the of effective informatics solution. of informatics solution. confidentiality 6.

educational principles. Implementing educational Using innovative activities for learners. educational techniques such as computer-based training or virtual reality as appropriate to learner populations and the specific informatics solution. e. Evaluating all aspects of educational activities. 10. Applies knowledge of product design, information technologies, strategies the for and client services to internal and external marketing activities to facilitate performance or solution. Standard V. Evaluate and Adjust Solutions The informatics nurse specialist evaluates all processes and solutions used to address the informatics problem. Measurement Criteria The informatics nurse specialist: a plan for 1. Uses a variety of methods to 3. the adoption of the

informatics individuals, communities, may include: a.

data and privacy for individuals. Ensures that the informatics standards and from solution is in compliance with recognized accrediting agencies. 7. Manages regulatory

affected by the solution, which

Adapting market analysis tools and techniques to identify changes recommended to the

implementing solution. 8. Applies

informatics

informatics solution. b. Using reliable and valid measures perceived responses c. to and to analyze actual the

systems testing methodologies to all phases of implementation of the solution, which may include: a. Developing for procedures, and and acceptance

informatics solution. Creating written plans for ongoing analysis of the informatics impact. Disseminates to results of solutions

policies, scenarios testing, b.

protocols, conversions,

interface testing. Developing testing conversion procedures. c. Developing for baseline system solutions and criteria acceptance. d. for Recommending problems implementation and backup

evaluation

colleagues,

stakeholders and others. 4. Reviews all prior steps in the process and

evaluate the structure, process, and outcome of the informatics solution, which may include: a. b. Assessing the ROI. Conducting realization appropriate implementation. c. Using summative and a benefits at intervals analysis

problem-solving may include: a.

makes recommendations, which

Systematically the quality effectiveness problem-solving

assessing and of the process

impediments identified during performance/system testing. 9. Manages education activities

during and after solution b.

and informatics solution. Using the results of the quality and effectiveness analysis to make process or or recommend

for the informatics solution, which may include: a. Developing an education d.

formative techniques for a comprehensive evaluation approach. Using reliable and valid

structural changes.

c.

Incorporating the results of evaluations into policy, procedure, or protocol documentation.

of

nursing

informatics for that

1.

Engages regular areas

in

and

conducts identifying

practice using structures developed purpose. d. Analyzing quality data to identify opportunities for improving nursing 2. informatics practice. e. Formulating recommendations improve informatics outcomes. f. Implementing activities to enhance nursing practice. g. Developing, implementing, evaluating procedures the quality policies to of and and improve nursing the quality of informatics practice to nursing or

performance appraisal on a basis, where areas of strengths as well as professional development is needed. Seeks constructive feedback

d.

Changing programs findings.

educational based on

5.

Uses

multiple

methods, and from

regarding ones own practice. 3. Takes action to achieve goals during performance

disseminates knowledge

information synthesized

evaluation activities.

identified appraisal. 4. Seeks

INFORMATICS SPECIALIST STANDARDS PROFESSIONAL PERFORMANCE

NURSE OF

peer

review

as

appropriate. Standard III. Education The informatics nurse specialist maintains knowledge and competency that reflects current nursing informatics (NI) practice. Measurement Criteria The informatics nurse specialist: 1. Maintains current skills and competencies. 2. Seeks skills new knowledge to and NI

Standard I. Quality of Nursing Informatics Practice The informatics nurse specialist evaluates effectiveness the quality of and nursing h.

informatics practice. Synthesizing about apply emerging to information and to

informatics practice. Measurement Criteria The informatics nurse specialist: 1. Integrates standards, regulations practice. 2. Performs quality improvement activities, which may include: a. Identifying nursing practice aspects important of for knowledge laws, into of 3. and

the existing standards the

nursing

appropriate

informatics practice. Implements changes the in results of 3.

practice through professional development activities. Seeks applicable. Standard IV. Collegiality The informatics nurse specialist certification, if

current professional practice informatics

quality activities to initiate nursing informatics practice.

Standard

II.

Performance

contributes to the professional development of peers, informatics colleagues, and others. Measurement Criteria The informatics nurse specialist: 1. Shares knowledge and skills with peers and colleagues. 2. Contributes to informatics

Appraisal The informatics nurse specialist evaluates professional and regulations. Measurement Criteria The informatics nurse specialist: ones own nursing standards and informatics practice in relation to practice relevant statutes

informatics

quality monitoring. b. Evaluating indicators used to monitor quality and effectiveness of nursing informatics practice. c. Collecting data to monitor quality and effectiveness

education of students, peers, and colleagues.

3.

Provides feedback practice.

constructive regarding others

autonomy, dignity, and rights. 6. Seeks available resources as 5.

procedures,

and

guidelines

based on systematic inquiry. Formulates an informatics

needed when formulating ethical decisions. Standard VI. Collaboration The informatics nurse specialist collaborates with others in the conduct of nursing informatics NI concepts (NI) practice. Measurement Criteria The informatics nurse specialist: 1. Collaborates with patients and families, and informatics others in clients, changes in

4.

Promotes understanding and effective use of information management and information technology.

research program.

Standards Utilization

VIII.

Resource

5.

Promotes understanding of NI by translating and practice to others.

The informatics nurse specialist considers factors related to safety, effectiveness, cost, and impact in conducting informatics practice. Measurement Criteria The informatics nurse specialist: 1. Evaluates factors related to safety, effectiveness, costs, and impact when developing and implementing information management solutions. 2. Applies strategies to obtain appropriate resources for informatics initiatives. 3. Assigns tasks or delegates responsibilities based on informatics conducted. 4. Promotes becoming adoption informed of about appropriately the activity nursing being

6.

Participates professional evaluate practice.

on teams

multithat

health

informatics

7.

Recommends

professionals, 2.

health care informatics using results from the evaluation of the quality and effectiveness of NI practice. Standard V. Ethics The informatics nurse specialist bases decisions and actions on ethical principles. Measurement Criteria The informatics nurse specialist: 1. Practices according to the

informatics activities. Collaborates with faculty in maintaining, educational and and developing, evaluating professional 3.

development

informatics programs. Collaborates with others in building the NI knowledge base. This may include activities such as research. Standard VII. Research The informatics nurse specialist contributes to the body of informatics knowledge. publishing, policy development, and/or conducting

current Code of Ethics for Nurses (ANA, 2001). 2. Develops methods to and

activities that assist others in costs, risks, and benefits of information management and information solutions. Standard IX. Communication The informatics nurse specialist employs communications. Measurement Criteria The informatics nurse specialist: 1. Is fluent in informatics effective technology available nursing

maintain knowledge. 3. of

confidentiality,

Measurement Criteria The informatics nurse specialist: 1. Integrates evidence best into

security of information, data, and

Advocates for appropriate use data, information, and 2.

informatics practice. Conducts systematic inquiry of informatics problems and issues. 3. Disseminates information and knowledge related to systematic inquiry. 4. Develops informatics policies,

knowledge. 4. and that Practices in a nonjudgmental nondiscriminatory is sensitive to manner human

diversity. 5. Practices in a manner that

preserves and protects human

terminology and standardized

languages. 2. Articulates requirements disciplines. 3. Interprets communication to and from others, such as informatics clinicians, professionals, patients, informatics to other

executives, and vendors. 4. Communicates concepts concisely. 5. Demonstrates persuasive complex

abilities in communication. 6. Applies established guidelines to written communication.