NURSING INFORMATICS

Introduction:

Nursing informatics is the speciality that integrates nursing

sciencewith the multiple information and analytical science to
identify, define, manage and communicate data information
knowledge and wisdom in nursing practice.
Health informatics focus on information technology to
positively impact the patient physicians relationship through effective
collection andunderstanding.
Terminology
1. Integrated:
To bring together curative and development aspect of patient
careinto one strategy.
2. Ethical:
Medical ethics deal with those ethical principles that
governprofessional conduct in medicine.
3. Legal:

Legal Medicine is the board concept incorporating both legal

andforensic training.

4. Aggregation:

Massing or clumping of materials together. A clumped mass

of occurrence of more cases of a given disorder in close relatives of a
personwith the disorder than in control families.

5. Synchronous:
Synchronous communication live and real time, happening,
exitingor arising at precisely the same time.
 Definitions:

1. Informatics:

Informatics is the study of structure behaviour, and interaction of

natural and engineered computational systems.

2. Health informatics:

It is focuses on the information technology to positively impact the

patient, physician, relationship effective collection, safeguarding and
understanding of the health data.

3. Nursing informatics:

Nursing informatics as the use of computers technology to the

support nursing including clinical practice, administration, education and
research.

Nursing informatics as the development and evaluation of

application, tools, processes and structure which assist with the management
of the data in taking care of patients or supporting the practice of nursing.

Meaning:
Informatics comes from French word informatique which means
computer science. Informatics is defined as computer science and
information science.
History:
a. In 1950 health care began to use computers.
b. In 1970 nursing began to realize the importance of computers to the
nursing profession.
c. In 1980 medical and nursing informatics specialities emerged.
d. In 1993 the American nursing informatics association.
 e. Nursing informatics has experienced rapid growth in the past 40 years
and it does not appear to be slowing.

General purpose of nursing informatics:

1. Computer generated client documentation.

2. Integrated systems allow nurses to make notes that everyone can access

meaning that each change shift runs smoothly.

3. Nursing informatics can also help with closing instruction, staff

assignments, and lab results.

4. Another function of nursing informatics is to help create care plans.

5. Nursing informatics makes use of the information coordinated by

technology to help nurses make better decisions.

Types of nursing informatics:

i. Human computer interaction

ii. Medical informatics

iii. Electronic medical record system

iv. Electronic health record

v. Medical information system

vi. Clinical decision support system

Human computer interaction:

Human computer interaction concerned with the interaction between

people and computers. As the study of how people design, implement, and
evaluate computers systems in the context of users tasks and work.
Medical informatics:

It is the systematic application of information, computer science, and

technology to public health practice, research and learning.

Electronic medical record system:

An electronic collection of the medical information about a person that is

stored on a computer. An electronic medical record include information about
the patient’s health history, such as diagnose, tests and treatment plans.

Electronic health record:

An electronic health record is a digital version of a patients paper chart.

EHR are real time, patient centered records that make information available
instantly and securely to authorized users.

Medical information system:

An interconnected set of components used to collect, store, process and

transmit data and digital information.

Clinical decision support system:

Clinical decision support provides clinicians, staff, patients or other

individuals with knowledge and person specific information, intelligently
filtered to enhance health and health care.

Trends in nursing informatics:

1. Past nursing informatics:

Nursing informatics was the first defined as the use of computer

technology to support nursing.

The first generation of nursing information system was designed to speed

paper work and communications.
 Until 1948 nursing primary care remained in the home.

2. Present nursing informatics:

Although the history of nursing informatics extends only some twenty

years. Today nursing informatics simplifies documentation and automates the
transmission of patient via connected devices to provide access by nurses,
physicians and patients.

3. Future nursing informatics:

1. Has introduced new challenges and opportunities along with new

computer application.

2. Nursing informatics future trends also will support patient data analysis.

3. Increased connectivity will improve knowledge sharing collaboration

between hospitals, doctors, and patients on a global scale.

Nursing informatics uses in hospital, community, education, and

research:

Nursing informatics in hospitals:

1. Storage of the patient data: Data has become an important part of

many health care. Nursing informatics is part of the development. To improve
the quality of care and out comes.

2. Computerized presentation generated nursing care plans and critical

pathways.

3. Computerized self-evaluation.
 4. Medical data-monitoring devices that record vital signs and other.

5. Create an integrated clinical system.

Nursing informatics in community:

1. They can record data about their health

2. National rural health mission
3. Primary health center
4. Automated staff scheduling.
5. E-mail for improved communication.
6. Cost analysis and findings trends for budget purposes.
7. Quality assurance and outcome analysis.

Nursing information in education:

1. Computerized record keeping.

2. Computerized assisted instruction.
3. Distance learning- web based course and degree programs
4. Power point and MS word for preparing slide-presentation
softwarepreparing handout.
5. Classroom technologies.
6. Internet resources formal nursing courses and degree programs.
7. Student and course management.

Nursing informatics in research:

1. Computerized literature searching. Medicine and web sources.

2. Uses of soft-ware (SPSS). The ability to find trends in aggregate
data,that is data derive from large population.
3. For research dissemination. Effective data management and trend
finding include the ability to provide historical or current data reports
 Role of the nurse in nursing informatics:

1. Registered nurses go beyond providing clinical care, to take on roles in

operations, education, leadership and technology in today’s health care
system.
2. Nursing informatics allows nurses to deliver evidence-based and
patient centered care, improve human health and advance medical
research.

Role of administrator nursing informatics:

1. Improve safety by utilizing technology to facilitate the collection,

analysis and reporting of higher quality data related to patient safety
issues and health.
2. 2. To prevent medical errors and allow for better monitoring and
reporting.

PATIENT RECORD SYSTEM:

Definition:

Patient record is a permanent written communication that documents

information relevant to the health care management.

Purpose:

1. Provide information on disease condition

2. Data for planning and evaluation to document clinical case history
3. To help in future program planning
4. Evaluation of services to assists in continuity of care
5. Research to furnish proof of type and quality of care

Types:

1. Dedicated patients health record

 2. Paper based record system
3. Health summaries

1. Dedicated patients health record:

A term used to describe the collection information generated to record the

clinical care and health status of an individual or health.

2. Paper based record system:

Medical records are combination of self-reported patient information and

clinical diagnostic notes traditionally stored on paper based mediums.

3. Health summaries:

Health system summaries are standalone, concise documents

summarizing the main elements of a country’s health system in an engaging
policy relevant way.

Principles:

1. Minimum records serve to document the history of the patient.

2. All entries to records should be signed put the data and time on all
records.
3. Record should be accurable and recorded in such a way that the
meaning is clear
4. Record should be readable.

Importance:

1. For individual and family:

• Records serve to document the history of the client

• Records assist in the continuity of care
 • Records serve as evidence to support or to manage or face the legal
questions that arise.
• Records serve to recognize the health needs and can be used as a research
and teaching tool.

2. For the doctor:

• Serve as guide for diagnosis, treatment, follow up and evaluation of

services.
• Indicate progress and continuity of care
• Help self-evaluation of medical practice
• Protect the doctor in case of legal issues. Records may be used for
teaching and research.

3.For the nurses:

• Provide with documentation of services rendered

• Provide data essential for planning and evaluation of services for
further improvement
• Serves as a guide for professional growth.
• Enables to judge the quality and quantity of work done.
• Indicate plans for the future.

4.For the authorizes:

• Provide the management with statistical information necessary for

decision in regard to utilization of resources, planning for
administrative control and future references.
• Help the supervisor evaluate the services rendered, teaching done
and a person’s action and reactions.
Value of nurse’s clinical record:

1. Provide baseline data for further plan of action

2. For diagnostic and treatment (eg) Evidence for patient care
management
3. To evaluate the workload, past and present medical conditions and
evaluate the nursing care.
4. Scientific and research purpose.
5. For legal purpose: Legal protection to hospital doctor’s and nurses

Issues in patient record systems:

1. Integrated systems require consistent use of standards in eg.Medical

terminologies.
2. Ethical, legal and technical issues linked to accuracy security
confidentiality.
3. Common records structures
4. Clinical information standards and communication protocols.
5. Security and confidentiality of information
6. Patient data quality: data sets, data dictionaries
7. Staff efficiency

Role of nurse in patient record systems:

1. The patient has a right to inspect and copy the record after being
discharged.
2. Failure to record significant patient information on the medical
records make a nurse guilty of negligence.
3. Medical record must be accurate to provide a sound basis for care
planning.
4. Errors in nursing charting must be corrected promptly in a manner
that leaves no doubts about the facts.
 5. In reporting information about criminal acts obtained during patient
care.

Role of administration in patient record systems:

1. It helps doctors and care givers to minutely assess and give the best of
medical facilities to the patient.
2. In addition a patient’s medical history allows him/her to take steps to
reduce his or her risk.
3. A patient medical records helps healthcare providers arrange for
regular checkup and tests for the people with medical condition.
4. A patient medical history can identify the changes of their probability
of having lifestyle diseases like diabetes and heart attacks.
5. The patient’s health records and history also can provide information
about the risk of more condition.

ELECTRONIC MEDICAL RECORD:

Definition:

A electronic medical record system is a type of clinical information

system which dedicated to collecting, storing, manipulating and making
available of clinical information. The central focus of such systems is clinical
data and not financial or billing information.

Components:

1. Result reporting in treatment, medication and lab tests

2. Data repository of allergies and complains
3. Decision support in physician, nurse and other clinician’s note.
4. Clinical messaging and e-mail
5. Documentation of flow sheets (vital signs, input and output problem
lists)
 6. Order entry of Discharge summaries

Benefits:

1. General:

• Improved data integrity: readable, better organized, accurate,

complete
• Improved productivity: access the data
• Increased quality care
• Increased satisfaction for care giver, easy access to client data.

2. Nursing:

• Decreased redundant data collection

• Allowed data comparison form prior visits
• Improved documentation and quality care
• Supported timely decision

3. Health provider:

• Improved documentation, reporting

• Prompted to ensure administration of treatment and medication
• Improved efficiency: eligibility, early warning of status changes

4. Patient:

• Decreased wait time for treatment

• Increased access/control over the health information
• Increased use of best decision support
• Greater clarity to discharge instruction
• Alert and reminders for appointments and scheduled tests
Technical features for EMR:

Electronic health record are a vital part of health contain a patient’s

medical history, diagnoses, medication, treatment plans, immunization dates,
allergies, radiology images, and laboratory and test results.

Issues of EMR:

1. The technical problem:

Connecting to the system and internet can be more difficult for a system
is located in as rural setting over an urban region.

2. The cost of use:

Advances in health information technology, such as EHR, can be

expensive in both implementation and usage.

3. The work flow break up:

Unfortunately getting paid said sometimes EHR implementation can

mess up the workflow in a practice entirely if it is not customized to fits its
purpose properly.

4. The concerns with privacy:

Some health care providers and patients may be concerned about

medicalprivacies when using EHR.

Legal issues of electronic health record:

1. Failure to maintain patient privacy and compliance.

2. Have error free maintenance lack of clarity related to informed
consent
3. Need to have a backup plan related medical malpractice risk
 4. Health records can be hacked failure to retain healthcare data for the
legally stipulated periods.

Role of nurse in electronic medical records:

1. Nurses uses modern technology to manage and organize patient

health information.
2. Categorizing patient medical record
3. Making them accessible and accurate for insurance purposes and
various database.

Role of administration in electronic medical records:

1. Medical record contains the patient’s identification information the

patient’s health history and medical examination findings.
2. Helps care provides give quality care by allowing quick access to
patient records resulting in more efficient care.
3. Hospital administrators ensure that operate efficiently and that
medical staffs members are adequately trained and supported.

E- NURSING:

Definition:

The use of computer or electronic device in some way to provide

training, education and learning. E- nursing comprises of all forms of
electronically supported learning and teaching.

Goals:

1. To enhance nurses to benefit from the developments in information,

communication and technology.
2. To improve nursing and patient information.
3. To encounter challenge owing to emergence of new technology.
Modalities of E- nursing:

1. Individualized self-paced E –learning online:

When a nurse accesses learning resources such nursing database online

through an internet.

2. Individualized self-based E – learning online:

When an individual nurse learner is using nursing database or a

computer assisted learning packages offline.

3. Group based E – learning synchronously:

When a group of nurses are working together in same time through

internet.

4. Group based E – learning asynchronously:

When a group of nurses are working over internet and they exchange
themselves with a time delay.

Style of E – nursing:

1. Offline and online activities:

Learning teaching activities takes place while offline example not

connected to an internet learning activities takes place while online example
connected to internet.

2. Synchronous and asynchronous:

Activities within synchronous learning, Learning and teaching takes

place in same time (real time). Within asynchronous learning the teaching
learning activities takes place with time delay(time-shift)
3. Different multimedia assets:

The activities are carries out through more than one media.

4. Different didactical interactions:

Approaches can be used such as assignment, assessment, pre-tests,

discussion, reading, workshop, demonstration, participating in a simulation ect.

5. Different way of delivering content:

Various way to deliver the content are computer, TV, mobile phone,
internet. Every device has its own characteristics, advantages and disadvantages.

6. Self – study:

Learning can be both ways: individualizes as well collaborative in e

learning.

7. Formal and informal learning:

Informal learning is unstructured, unplanned formal is a learning that is

planned with specified learning objectives.

Importance:

1. To organization improve training costs. Decrease material costs,

increased productivity, and standardization.
2. To learners real time access cost effective interactivity good learning
environment improve retention individualized learning.
3. To organization/ community ongoing access to resources. Knowledge
management. Encourage sharing of resources.

E – Health term:

1. Doctors
 2. Nurses
3. Pharmacists
4. Technicians
5. Administrator

Issue e – nursing:

1. Caring (essence of nursing is contact and engagement with

people,which involves physical closeness, intimacy)
2. Empowerment
3. Self – reflection and expression
4. Confidentiality
5. Networking problem
6. Patient education community development

Advantages:

1. It enhances innovative teaching

2. It promotes self-direct learning
3. Convenient for the learner
4. It promotes internet use
5. E- learning saves time and place for learning

Disadvantages:

1. Some forms of e – learning perceived as isolating from the personal

touch.
2. Nurses may not have the IT skills needed to take advantages of
learning.

Role of nurse in e – learning:

1. Health advisors
 2. Internet guides to help clients select reliable information resources
3. Support group liaisons
4. Web information providers
5. Nurses need to be involved in the design and implementation of e
health portals and programs that provide the best possible experience
for health care clients.

Role of administration in e – learning:

1. Increase retention and application information

2. Improve information and knowledge of nursing practice.
3. New models of nursing practice and health services delivery will be
supported.

TELEMEDICINE:

Definition:

The delivery of health care services of health care professionals using

information and communication technologies to people living distant areas to
exchange information.

Objectives:

1. To provide specialized medical advice

2. To monitor patient condition
3. To guide other medical staff about treatment procedure
4. Share patient data among institution for research purpose

Types:

1. Store and forward telemedicine

2. Remote monitoring
3. Real time interactive services.
1. Store and forward telemedicine

Store and forward telemedicine surpasses the need for the medical
practitioner to meet in person with a patient. Instead patient information such as
medical images or biosignals can be sent to the specialist as needed when it has
been acquired from the patient.

2. Remote monitoring

Also known as self – monitoring or self - testing, remote monitoring

uses a range of technological, devices to monitor the health and clinical signs of
a patient remotely.

3. Real time interactive services

Interactive services can provide immediate advice to patient who

require medical attention. There are several different mediums utilized
for this purpose, including phone, online, and home visit.

Benefits:

1. Window to expertise care

2. Economic for hospital and patient
3. Reduce the stress in patient and relatives
4. Save travel time of specialist and patient.
5. Good for education and research purpose.

Staffing:

1. Head of the department

2. Consultant
3. Network manager
4. Program manager
5. Web developer
 6. Telemedicine technician
7. Telephone attendant

Location:

Location can be located at any non prime location way form the patient
traffic near to communication system satellite.

Layout:

1. Reception
2. Telemedicine conference hall
3. Telemedicine library
4. Cafeteria
5. Restrooms

Role of nurse in telemedicine:

1. Accessing, observing, and speaking to patients.

2. Recording details and symptoms of patient medical history and
current health.
3. Preparing patients for exams and treatment.
4. Administering medication and treatment, then monitoring patients
for side effects and reaction.
5. Performing wound care, such as cleaning and bandaging them.
6. Operating and monitoring medical equipment.
7. Educating patients and family members on treatment and care plans,
as well as answering their questions.

Role of administrator in telemedicine:

1. Technology can play a facilitating role particularly in reaching out

too remote location
 2. In this method of treating and diagnosing patients remotely through
communication

TELENURSING:

Definition:

Tele nursing refers to the use of telecommunication devices and

information technology to provide nursing care from a distance to isolated
group of people.

Objectives:

1. To deliver care and expertise

2. For curative, preventive and rehabilitative
3. For training and information.

Qualification:

a) Associate degree in nursing

b) Bachelor’s degree in nursing
c) Pass the NCLE receive RN licensure
d) Certificate Telehealth nurse

Scope in telenursing:

Assistance to physicians in the implementation of medical treatment

protocols

1. Nurses
1. Actually view healing wounds
2. Provide routine assessment and follow up care.
3. New technologies have added a visual component to the
interactions that augments the historic audio exchange.
Home care

1. In normal home health care one nurse is able to visit up to 5 – 7

patients per day.
2. Using tele nursing one nurse can visit 12-16 patients in same
amount of time.

Principles:

1. Improve and enhance the quality of care

2. Existing health care services
3. Reduce the delivery of unnecessary services.

Guidelines for tele nursing practice:

Tele nursing consulation need to be structured to provide optimal care to

the patients. The following elements to be considered before beginning any tele
nursing consultation.

1. Context
2. Identification RN and patients
3. Mode of communication
4. Consent
5. Assessment and communication to the patient related information
with RMP
6. Patient management
7. Professional accountability and responsibilities of the
registered nurse.
Frame work of Tele nursing

Nurse

Nurses offers
Client
own solution
describes
based on
the problem
experience
to the nurse

Client

Informal tele nursing interaction

Medical
care 2h
GP
Medical
within
care

Nurse offers
predetermined care homecare
000 options based on
urgency

Client describes
the problem to
nurse

client
Legal and ethical issues in Tele nursing:

Legal issues:

1. Licensing
2. Scope and practice
3. Safety
4. Security
5. Accountability
6. Legal competence

Ethical issues:

1. Central and concept in nursing

2. Communication skills competing interests
3. Competing interests

Advantages:

1. To increases the access to health care services

2. To reduce cost
3. To reduce the visiting / waiting / unnecessary visit to hos[ital.
4. To provide immediate health care information to solve the problem
5. Medicare reimbursement
6. Improvement resource and time allocation
7. Help solve increasing shortages of nurses
8. Minimize the length of hospital stay.

Disadvantages:

1. In a medication administration example, patient made medication

administration error
2. Stress and potential error
 3. False diagnosis
4. Networking connection error

Role of nurse in tele nursing:

1. Recording vital signs including oxygen level.

2. Monitoring patient progress and updating patient medical records as
needed.
3. Responds to patient experiencing cardiac pain.
4. Technical skill is needed by nurses.

Role of administrator in tele nursing:

1. Clinical services can be realistically delivers via health.

2. Billing codes should also be used using tele health services.

2. Parallel method:

• The selected new system is installed and operated with current system.
• This method is expensive because of duplicating facilities and
personal to maintain both system.

3.Modular method:

This is generally recognized as pilot approach means the implementation

of a system in the organization on a piece meal basis.

Advantages:

1. The risk of system failure is localised.

2. The major problem can be easily identified.
3. It supports and enhances the overall decision making process.
Disadvantages

1. Highly sensitive, require constant monitoring.

2. Budgeting
3. Lack of flexibility to update.
4. Effectiveness decrease due to frequent changes in top management.

Role of administrator management and evaluation system:

1. Management information system are used to process information both

at strategic and operational level to monitor activities.
2. Access and plan new services.
3. Monitor trends which enables senior managers.
4. To effectively manage the strategic direction of an organization.

Journal Abstract:

1. Rami Ibrahim Al Najjar, International of medical science and clinical

research studies ISSN, May 21, 2022. “Impact of nursing informatics on

the Quality of patient Care” Currently nursing informatics is a part of

nursing field by bridging the gap from nursing to nursing as a science.

Additionally nursing informatics actively reinforces nursing by providing

standard language systems, decision making support, technological

advancements, and enhanced relationships between patients and clinical

professionals. This article aims at assessing the impact of nursing

informatics on the quality of patient health care.

BIBLIOGRAPHY

TEXT BOOK

1. Dee McGnigle, Kathleen Mastrian, “Nursing Informatics” Jones and

Bartlett Publishers, Pge. No: 29-50, 219-231, 265- 280.

2. Elakkuvana Bhaskara Raj. D, “Management of Nursing services and

Education” 2nd Edition, EMMESS Publishers, Page. No:475.

3. Potter Perry , “Fundamentals Of Nursing, &7th edition, Elsevier publishers,

New delhi, Pag. NO: 147.

JOURNAL REFERENCES:

1. Saied El. Nagger, 2016, Evolution of nursing informatics, A key to

improving nursing practice, Research journal of Medicine and Medical

Science, pg. no: X- X5.

2. Rami Ibrahim Al Najjar, International of medical science and clinical

research studies ISSN, May 21, 2022. “Impact of nursing informatics on

the Quality of patient Care”

ELECTRONIC VERSION:

1. WWW. Slideshare. Com

2. https; //www.times. org>.

 CHRISTIAN COLLEGE OF NURSING,
NEYYOOR.

SEMINAR

ON

NURSING INFORMATICS

SUBMITTED TO SUBMITTED BY

Dr. A. Femila Darling,Ph.D(N) Anne Jakuline Princy.P

HOD of Community Health II year MSc.,(N)

Nursing