Nursing Informatics Specialists and Nursing Education: The Need for Collaboration.

Presented at the 2004 Summer Institute of Nursing Informatics on July 23, 2004 by

Jeanne Sewell, RN, MSN and Linda Q. Thede, Ph.D, RN, BC

Driving Forces for Improving Nursing Informatics Education
1. The federal government
  1. President’s Information Technology Advisory Committee (PITAC) - In June 2004, a report was made to the President (PITAC, 2004)that emphasized the need for promoting the electronic health record, clinical decision support, and computerized provider order entry.
  2. National Committee Vital & Health Statistics (NCVHS) is developing strategies supporting a National Health Information Infrastructure (NHII)(National Committee Vital Health Statistics, 2001). The objective is to help health care decision makers and providers and patients in all settings to access health information.
  3. Consolidated Health Informatics (CHI). This is a component of the President’s Management Agenda. The focus is the adoption of electronic health messaging and vocabulary interoperability standards for use in the federal healthcare enterprise (Bradford, 2004).
2. The Institute Of Medicine (IOM) has made several reports to improve health care that require informatics.
3. The IOM report Health Professions Education: A Bridge to Quality (Greiner, 2003). [Also available at http://www.nap.edu/books/0309087236/html/]. lists the core competencies that they see as being required of ALL healthcare professionals. There are five overall core competencies discussed.
  1. Provide patient centered care
  2. Work in interdisciplinary teams
  3. Employ evidence-based practice
  4. Apply quality improvementUtilize informatics
4. In the report Crossing the quality chasm: A new health system for the 21st Century 10 rules are presented. Informatics is applicable in all these rules(Institute of Medicine, 2001). See http://www.nap.edu/books/0309072808/html/
Forces Supporting the Inclusion of Nursing Informatics in a Curriculum
1. Greiner in Health professions education: A bridge to quality states that “Without a basic education in informatics, health professionals are limited in their ability to make effective use of communication and information technology in their practice.” (Greiner, 2003) p.85.
2. In 1997 the Division of Nursing of the Health Resources and Services Administration - convened a National Advisory Council on Nurse Education and Practice. They produced a National Informatics Agenda for Education and Practice. One of their recommendations was for including core computing and nursing informatics concepts in nursing curricula (National Advisory Council on Nurse Education and Practice, 1997). They also identified eight categories of nursing informatics needs. See the report at ftp://ftp.hrsa.gov//bhpr/nursing/nireport/NIFull.pdf.
3. The American Association of Colleges of Nursing;s list of core competencies in Information and Health Care Technologies includes the following skills as necessary(American Association of Colleges of Nursing, 1998).
  1. The use information and communication technologies to document and evaluate pt care, advance pt education, and enhance accessibility of care
  2. The use appropriate technologies in assessing and monitoring
  3. The ability to work in interdisciplinary teams to make ethical decisions regarding the application of technologies and acquisition of data
  4. The ability to adapt the use of technologies to meet pt needs
  5. The ability to teach patients about health care technologies
  6. To be able to protect safety and privacy of patients in relation to the use of health card and information technologies.
    vii. To be able to use information technologies to enhance one’s own knowledge base.
4. The American Nurses Association (ANA) in the Scope and Standards of Nursing Informatics maintain that all nurses need computer and information literacy (American Nurses Association, 2001)
5. A recent survey (Uttley-Smith, 2004) of nursing administrators from hospitals, home health agencies, and nursing homes in NC, SC, and TN found that one of the five competencies wanted by nursing administrator’s was computer technology. Under that category they list:
  1. Demonstrates computer literacy
  2. Is able to access and retrieve electronic data necessary for patient care
  3. Uses information technology to facilitate communications, manage data sets, and solve patient care problems.
Difficulties Implementing Nursing Informatics Education
1. Some schools still do not teach informatics. Although we hope this has changed a in a 1998 survey it was found that (Carty, 1998)
  1. There are many graduates who who are computer illiterate, or have minimal knowledge that needs remedial teaching by hospitals.
  2. New graduates have little understanding of how knowledge functions in healthcare thus cannot help nursing informatics specialists to build systems that serve nursing and provide information to support and improve nursing care
2. In a recent report Dean Miller of University of Kansas said “We’re graduating students today who’re fairly ignorant about the technology that’s out there.” (Weber, 2004)
3. There are an inadequate number of faculty qualified to teach informatics. McNeil (McNeil et al., 2003) found that “Faculty who were rated at the ‘novice’ or ‘advanced beginner’ level for teaching information technology content and using information technology tools are teaching information literacy skills.” (p341). Compounding the problem, there is a lack of time for faculty development (Carty, 1998) p263
4. Too many faculty do not realize the importance of informatics
5. There is a lack of a clear understanding of informatics as a discipline along with an overcrowded curriculum (Greiner, 2003).
6. Lack of easy access to local informatics experts (Greiner, 2003) p 86 only one part of informatics - the other part is applying informatics to patient care)
7. There is a tendency to equate informatics with the use of computers to deliver education (Greiner, 2003) rather than managing information.
Current Collaboration Projects
1. University of Kansas partnership with Cerner (Weber, 2004)
2. New York University Medical Center Educational Services Department - established multi-disciplinary informatics curriculum for all. They offer courses in such areas as basic computer skills, identification of information resources, structure of information, development of search strategies in support of EBP, the identification of qualitative journals and the critical appraisal of the literature.”(Greiner, 2003)
Possible Collaboration Actions
1. Faculty actions that could promote nursing informatics education
  1. Become acquainted with the individual responsible for informatics on the unit where you have students.
  2. Find out what knowledge and skills the nursing informatics specialists would like a beginning nurse to have, graduate nurse.
  3. Take any classes in the hospital where you have students, learn the system, ask questions, become acquainted with the teacher in those classes.
  4. Join any local informatics groups, or attend their meetings. Network!
  5. Ask a knowledgeable person to do a guest lecture on how information is use in the agency. Could be part of a clinical course or informatics course. (Harbeson, 2004)
  6. Ways to become educated about informatics
    1. Invest in an informatics book or two.
    2. Spend an afternoon every month in the library reading about nursing informatics. Take notes and ask those in the agency where you have clinicals about what you learn.
  7. Dialog with other faculty members about the importance of informatics.
  8. Show and explain to students how informatics can make a difference
  9. Encourage the use of an electronic charting program in the skills lab - e.g. ChartSmart. Students need experience with electronic order entry, order tracking, reports, and data sharing (Harbeson, 2004)
  10. Ways to integrate informatics into the curriculum
    1. If a separate course, be sure that the material is integrated into the rest of the curriculum.
    2. Integrate with various parts being assigned to various courses.
    3. Above all, there should be a carry through in the entire curriculum.
    4. See if the training hospital where employees are trained for a system could be made available to SON
  11. If there is a user group for a system at the agency where you do clinicals join it.
2. In house nursing informatics specialists actions that could improve nursing informatics education.
  1. Seek out any faculty who have students in your area and offer to provide a guest lecture. (Harbeson, 2004)
  2. Talk about how informatics can add to nursing
    1. evidence-based practice
    2. getting aggregate data
  3. Meet with the Dean or faculty teaching informatics to discuss any differences between what is being taught and the skills the graduates need. (Harbeson, 2004)
  4. See if your vendor can provide a demonstration system for the SONs who do clinical in your agency. (Harbeson, 2004)
  5. Offer to do an in-service at a school of nursing for faculty. Arrange for contact hours to be awarded. Explain the ways that collected data can be used to improve practice.
  6. Network with faculty.
  7. Provide learning experiences for all students in informatics. Offer one day experiences with you to students in their clinicals
  8. Offer to be a preceptor for a student in their management course (or whatever course where they shadow a practicing nurse).
  9. If your agency won’t let student chart, see if a “Nursing Student” security position can’t be built that would allow access to those pieces of the EMR that are appropriate, e.g. vital signs, intake and output, ACL etc. (Harbeson, 2004)
  10. Help to develop a network/system password-naming convention to identify all students during their clinical periods (Harbeson, 2004).
  11. Add a “Student Nurse Notes” section to the EHR (Harbeson, 2004).
What Informatics Competencies Are Needed?
1. See http://www.nurs.utah.edu/informatics/competencies.htm. This is a Word document of the competencies that are discussed in the Staggers, Gassert and Curran article in Nursing Research (Staggers, Gassert, & Curran, 2002.
2. Ronald, J. & Skiba, D. (1987). Guidelines for basic computer education in nursing. NLN Pub No 41-2177. New York: National League for Nursing.
3. McNeil, B. J., Elfrink, V. L., Bickford, C. J., Pierce, S. T., Beyea, S. C., Averill, C., et al. (2003). Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: a U.S. survey. Journal Nursing Education, 42(8), 341-349.
4. Staggers, N. G. C. A. C., C. (2001). Informatics Competencies for Nurses at Four Levels of Practice. Journal of Nursing Education, 40(7), 303-316.
5. Nursing Informatics Competencies Self - Assessment site. This site has some dead links, but what is there is valuable. http://www.nursing-informatics.com/

References

American Association of Colleges of Nursing. (1998). The Essentials of Baccalaureate Education. Washington, D.C.: American Association of Colleges of Nursing.

American Nurses Association. (2001). Scope and standard of nursing informatics practice. Washington, D.C.: American Nurses Press.

Bradford, A. A. W., C. (2004). Consolidated Health Informatics Initiative. Caring., 19(2), 1-3;4.

Carty, B., & Rosenfeld, P. (1998). From computer technology to information technology: Findings from a national study of nursing education. CIN: Computers, Informatics, Nursing, 16(5), 259-265.

Greiner, A. C., & Knebel, E. (Ed.). (2003). Health professions education: A bridge to quality. Washington, D.C.: National Academy Press. http://www.nap.edu/books/0309087236/html/.

Harbeson, G. (2004). ANIA News: The nurse informatics professional and the student nurse. CIN: Computers, Informatics, Nursing, 22(3), 113-114.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st Century (2001). Washington, DC: National Academies Press. http://www.nap.edu/books/0309072808/html/.

McNeil, B. J., Elfrink, V. L., Bickford, C. J., Pierce, S. T., Beyea, S. C., Averill, C., et al. (2003). Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: a U.S. survey. Journal Nursing Education, 42(8), 341-349.

National Advisory Council on Nurse Education and Practice. (1997). A National Informatics Agenda for Nursing Education and Practice. Washington, D.C.: Health & Human Services. ftp://ftp.hrsa.gov//bhpr/nursing/nireport/NIFull.pdf

National Committee Vital Health Statistics. (2001). A strategy for building the National Health Information Infrastructure: U.S. Department of Health and Human Services. http://ncvhs.hhs.gov/nhiilayo.pdf.

PITAC. (2004). Revolutionizing Health Care Through Information Technology. Washington, DC: President's Information Technology Advisory Committee. http://www.hpcc.gov/pitac/meetings/2004/20040617/20040615_hit.pdf.

Staggers, N. G. C. A. C., C. (2002). A Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research, 51(6), 383-390.

Thompson, T. G. (2004, May 6, 2004). Health Information Technology Summit. Retrieved June 16, 2004, from http://www.hhs.gov/news/speech/2004/040506.html

Uttley-Smith, Q. (2004). Competencies needed by new baccalaureate graduates. Nursing Education Perspectives, 25(4), 166-170.

Weber, D. (2004). Transforming the students nurses experience: A university integrates e-health technology into the nursing curriculum. Patient Care Staffing Report, 4(2), 1-3.

Posted July 18, 2004 by