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"Registered nurses need to be able to demonstrate their unique contribution to the health of Canadians within Canada's rapidly evolving health care system. Basic, essential nursing information is required by nurses, employers, researchers, educators, policy makers, and clients so that informed decisions can be made about nursing's role in the changing health care system," - Canadian Nurses' Association, 1993: Policy Statement on Health Information: Nursing Components, p. 1.
The use of technology in nursing is not new, in fact nurses have become proficient in
utilizing and adapting complex technology into caring nursing practice for decades, at least since the time of Florence Nightingale in the United Kingdom and even earlier, when Jeanne Mance (1606-1673) founded the first hospital in Montreal,Canada in 1642. Various forms of machinery such as ventilators and physiological monitors were first used in intensive and critical care settings, and are now currently used in adapted form in less acute areas, even in home care. Nursing has evolved significantly over the past few decades, with many of the changes being driven by advances in information and communication technology (ICT). ICT has permeated all aspects of society, including health care and affects all members of the interdisciplinary health team. Since nurses are the largest group of health care providers, discipline-specific competencies in the use of ICT and other technologies are imperative. This realization has catalyzed the steady development of nursing informatics. Nurses in Canada have made an enormous contribution to all aspects of Canadian society. Their involvements have influenced the wider social, economic and political history of Canada, as well as the history and politics of health care. Nursing history provides the public with valuable perspectives on emerging technologies, health care reform and gender issues in Canadian history (Canadian Nurses Association, 2004, p. 2).
information system that required nurses to enter common data such as admission profiles and basic care requirements like diet, medications, and treatments into a computer as part of their routine duties.
The first phase of the project was the development of a Discussion paper in 1999, and the
collection of feedback on key issues related to nursing informatics competencies development from Canadian nurses.
The Nursing Minimum Data Set was the first major Canadian
Nurses Association informatics initiative beginning in 1990. This was in response to the strong conviction that nursing data must be included in the centralized national health data system being planned by the Canadian Institute of Health Information (CIHI) described in Chapter 2.Registered nurses, as the single largest group providing health care services, play a major role in health care in Canada. Incredibly, this contribution is not abstracted from client records and saved in a permanent database of health information. Most health care data collected in Canada include medical diagnoses and interventions but do not reflect the contribution of other
health care professionals. Decisions are made in the absence of data reflecting the value of nursing (Canadian Nurses Association, 2000, p. 5). .The Canadian Nurses Association considered it imperative that nursing data, that distinctly reflected nursing care became part of the permanent health record being designed for the nation. The impact of nursing should be captured in national health care databases through the use of effective nursing classification systems (Canadian Nurses Association, 2003, p. 1).
Another influential group, the Canadian Institute for Health Information (CIHI) also
plays a unique and crucial role in the development of this new Canadian health information system. CIHI has described its' role as: 1. Setting National standards for financial, statistical, and clinical data 2. Setting National standards for health information technology, 3. Collecting, processing, and maintaining health related databases and registries
The CIHI links federal, provincial, and territorial governments with non-government,
health-related groups. Rhial LeBlanc, President and Chief Executive Officer of CIHI described the organization as having one main focus, "The work of health care facilities and professionals is what CIHI supports, and truly improving that service is our constant objective," (1996, p.1). LeBlanc was clear that CIHI exists to "...serve all elements of Canada's health care system in an equal and responsive way." Even though CIHI was initially formed by federal, provincial, and territorial Ministers of Health, the Institute has been given latitude to grow and chart it's own course. CIHI members have chosen to keep at "arms-length" from the various levels of government and do not report directly to government officials. The Canadian Nurse's Association (CNA) and the provincial nursing associations (for example, the R.N.A.B.C.) plan to link more and more with CIHI in the future.
The CIHI helped introduce the Strategic Plan for Health Information Management in British
Columbia in 1996 that provides guidelines for holistic assessment and processing of information. The Plan is based on the four domains of people, environment, health system and processes. In 1995, the CIHI initiated a project to provide a cohesive set of guidelines
for Canadian health information privacy. In 1999, a second edition of these guidelines was produced, which incorporated issues related to the advancement of health information and techology. In 2002, an updated version Privacy and Confidentiality of Health Information at CIHI: Principles and policies for the protection of health information , the 3rd edition is available in PDF (437 k) format
associations, consultants, vendors of information technology and applications, government and regulatory organizations in the pursuit of its mandate.
The backgrounds of COACH members range from health executives, physicians, nurses and
allied health professionals, researchers and educators to information systems managers, technical experts, consultants, and information technology vendor representatives. Organizations represented include the broad range of healthcare institutions, community and public health, private practice, government, consulting firms, commercial providers of information and telecommunications technologies, educational institutions and industry.
Various nursing programs are beginning to offer courses and content in Nursing
Informatics. Some programs integrate informatics into individual courses, which is the model we have adopted in the BSN Nursing Program at Kwantlen. Others offer individual stand alone courses which provide computer skills and some theory. A generous list of educational opportunities in informatics is available on the CNIA site
Slowly but steadily, other colleges and universities are expanding their curricula to include
Nursing Informatics at both the undergraduate and graduate levels. As more nurses become computer literate, and become aware of the potential of technology to support nursing documentation, decisions, and professionalism, Nursing Informatics can become a strong and integral part of Canadian nursing science. With this goal in mind, the The BSN Nursing Program has adopted Nursing Informatics as an integral component of the curriculum.
The CNIA conducted a study in 2002 - 2003 on the Informatics Educational Needs of
Canadian Nurses, funded by the Office of Health and the Information Highway, Health Canada or OHIH calledEducating Tomorrow's Nurses: Where's Nursing Informatics?
The intent of the study was to describe the current state of:
informatics education opportunities currently available to students of nursing across the country, the level of preparedness of nursing faculty to deliver these offerings, information and communication technology infrastructure and support for faculty in delivering these offerings, and opportunities to enhance nursing curricula, faculty preparedness, and ICT infrastructure and support in schools of nursing across Canada.
advocating for the involvement of nurses in decision-making about information technology and information systems. (Canadian Nursing Association, 2006, p. 10).
The e-nursing strategy will address these goals by adopting a three pronged approach:
Access better connectivity in work environment, more access to a variety of computer technologies, e.g. PDAs, hardware, software, station computers. Competency- ongoing ICT skill development, integration into nursing curriculum Participation - as knowledge workers in this technological age, it is essential that nurses play an increased role in the development of ICT solutions (Canadian Nursing Association, 2006, p. 15).
Kwantlen Polytechnic University offers The BSN Nursing Program which integrates both
theory and practice of Nursing Informatics across the program in BC, Canada. The faculty of the BSN Nursing Program fully support that Nursing Informatics is central to nursing in the various domains of practice. Since 1996, Kwantlen University College faculty have integrated Nursing Informatics into all eight semesters of the program.
The Nursing Informatics learning activities in this program encourage you the student to
develop your literacy in a number of computer applications. Word processing, graphical design, using databases, desk-top publishing, spreadsheets, using the Internet, web page design, multimedia design and the use of Nursing Information Systems (NIS) are some examples.
With the advent of this online version of the Kwantlen Polytechnic University BSN
Program's Nursing Informatics learning activities in 1999, new modes of interaction and computer use were made possible. As both faculty and students become more comfortable and adept in using computer applications, creative use of computers can become more prevalent in the program. In time, interactive communication using computers will occur as easily as in class communication.
As well, more extensive web site design; use of virtual reality; establishing links with local
health care agencies, and with schools in other national or global areas can eventually be incorporated. The possibilities are endless - only availability of funds, level of computer literacy, commitment and access to knowledge about new developments in the field inhibit the process.