purpose of nursing informatics essay

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The Future of Nursing Informatics in a Digitally-Enabled World

• First Online: 05 January 2021

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• Richard Booth 3 ,
• Gillian Strudwick 4 , 5 ,
• Josephine McMurray 6 ,
• Ryan Chan 3 ,
• Kendra Cotton 3 &
• Samantha Cooke 3  

Part of the book series: Health Informatics ((HI))

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The nursing profession has a history of embracing novel technologies that support the delivery of compassionate, person-centred care. The emergence and rapid adoption of ‘intelligent’ technologies that have the ability to act autonomously, but that are often embedded and ‘invisible’ to users, is challenging the nursing profession to reconsider their role in the health system of the future. Using a socio-technical lens the authors examine artificial intelligence and process automation technologies because of their significant potential to become much further embedded into nursing work and disrupt the healthcare system as we know it. Opportunities for nurses to transform their role in the healthcare value chain, will arise from the profession’s proactive reconceptualization of the nursing role in an era where technology is moving from discrete transaction processing and monitoring applications to pervasive computing. But the nurse’s traditional patient and family advocacy role will remain important, as policy, regulatory and ethical challenges arise from the development and use of these emergent digital technologies. The rapidly changing healthcare ecosystem demands nursing involvement in the research, design, adoption and use of emergent digital technologies. The subtle normalization of these technologies into the nursing role will require new nursing knowledge and skills, and different relationships between nurses (i.e., practice, education, research, leadership) and other actors (i.e. patients, physicians, technologies) in the healthcare ecosystem of the future.

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Technology that has the ability to perform actions or tasks (e.g., decision-making) which would normally require some degree of human intelligence

A term used to describe the extensive volume of both structured and unstructured data generated in the healthcare system

Robotics process automation that work in close collaboration with humans to complete shared tasks

An approach to learning through examination and discussion

Technologies that provoke change and innovation, resulting in new or unanticipated opportunities

Technologies that are developing and evolving to become useful or impactful in a variety of settings across society, including healthcare

Factors impacting change and adaptation that the organization can try to influence but not control

Resistance to change

Factors impacting change and adaptation that are within the scope of influence or control of the organization

An individual that provokes or supports transformative change within an organization

The phases of a specific process from beginning to conclusion, commonly reflecting software development or project management

An approach to options analysis by calculating the incremental impacts of change on cost and revenues

Graphical representation of the connection between concepts and ideas

An emerging field of research focused on microscopic robots used to target specific diseases such as cancer

A security authentication with a high degree of confidence

The process of becoming accustomized to a specific concept or process, such as the use of technology to perform a specific task, so that it this is perceived to be part of a normal routine.

Non-repudiation of Origin, which documents evidence of origin of the message, and prevents denial of the message by the originating party

An approach to decision making that involves Observing information, Orienting or interpreting information, Deciding on a course of action, and Action

The day to day management of the healthcare system, which includes a variety of departments or services such as human resources, administrative, finance, and inventory

Two approaches to change reflecting both adaptability and alignment

Specific criteria that are measured at specific points in time to evaluate performance and/or change

Automation that reengineers processes to minimize human effort and increase both efficiency and productivity

Nightingale’s visualization depicting mortality causes

Plan to provide oversight or resolution to an issue related to a specific service or product provision

Refers to the relationship between technology and the social aspect of actions that are influenced by the inclusion of technology in activities

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Booth, R., Strudwick, G., McMurray, J., Chan, R., Cotton, K., Cooke, S. (2021). The Future of Nursing Informatics in a Digitally-Enabled World. In: Hussey, P., Kennedy, M.A. (eds) Introduction to Nursing Informatics. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-030-58740-6_16

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What Is Nursing Informatics and Why Is It So Important?

If you’re considering a career in nursing informatics, here’s what you need to know. Many people are unaware of What nursing informatics is and why it is vital to medical research, healthcare, and patient care.

You’re not alone if you don’t know precisely what Nursing Informaticists do. The pandemic of Covid-19 shows everyone why Nursing Informatics is so essential.

Developing a deep understanding of nursing informatics will enable nurses to solve their most pressing problems, and that’s why we will share some information about what nursing informatics is and why it is so important?

Salary and Employment in this exciting field:

What is nursing informatics.

Nursing Informatics offers powerful resources to help meet these responsibilities and improve the standard of care. It’s a system that helps track patient health data, records clinical outcomes, monitors the quality of healthcare delivery, and evaluates provider performance.

The goal is to provide an effective tool for nurses who need better ways to manage their patients’ information while providing optimal care at the same time. This field can accomplish this through improved access to timely medical research findings or autonomously predicting drug development problems.

Nursing informatics is a relatively new field of study that provides nurses with the necessary skills to use information technology to improve healthcare.

The nursing informatics degree prepares nurses for these future demands by providing them with the knowledge and skills needed to work within an ever-changing technological environment.

Why Is Nursing Informatics So Important?

To provide safe patient care, nurses must have access to accurate information on the patient, such as his or her medical history, medication list, lab results, and physician team notes.

Informatics is a system of organizing and utilizing data to solve problems. With the widespread use of electronic medical records, nurses have access to information that can help them assess patients more accurately and make better decisions about their care.

For Example, before CPOE, nurses had to transcribe provider orders by hand, which was caused by handwriting that was hard to read and human error, resulting in medication errors, delays, and omissions.

From this, you can see why nursing informatics is essential for nurses and the entire health care organization.

How Nursing Informatics Improves Patient Care

Nursing informatics can improve communication between health professionals by providing them with more accurate information about patients and their treatment plans, thus allowing better decision-making regarding medication administration or treatments that are needed for the patients.

It encompasses a wide variety of fields such as computer science, data management and analysis, healthcare policy research, clinical decision support systems for nurses, design of software to assist with patient care or education.

Careers in informatics for nurses

Informatics has become a significant part of nursing practice through patient records and other technology.  The demand for qualified nurses has grown exponentially in recent years, and those who study informatics are swamped with career opportunities.

Following career paths are available in this lane:

• Clinical informatics manager
• Clinical analyst
• Nursing informatics specialist
• Nursing informatics analyst
• Clinical informatics coordinator
• Clinical informatics specialist

There has been an increase in the need for clinicians who specialize in using medical technologies at hospitals around the country since they help facilitate efficient coordination among caregivers, helping manage chronic conditions like diabetes and congestive heart failure while also identifying gaps in care.

The first step on your journey toward a nursing informatics degree is deciding which type will be best for you: undergraduate or graduate level? Undergraduate programs offer courses that prepare students for entry-level positions in health IT; graduate programs provide more advanced instruction tailored towards leadership roles.

Some Requirements for this Job

If you are looking for an opportunity, make sure you have these skills or qualifications for a job in the Nursing Informatics field.

• A bachelor’s degree in nursing (BSN)
• Certifications and a master’s degree
• Experience and strong knowledge of working in a clinical setting 
• Skills in technology and innovation; ability to adapt quickly to new technologies
• Excellent project management skills
• The desire to gather, analyze, and strategize about data
• Knowing medical economics
• Strong interpersonal skills
• Leadership experience
• Effective interpersonal skills

Informatics nurses can earn between $56,369 and $97,367 per year, with an average salary of $79,631. Salary can depend on additional degrees or certificates held, the city and state they work, experience, and the organization.

Source: Payscale

Generally speaking, the field of nursing is overgrowing, and in the future, it is projected to grow more than any other occupation.

The American Nurses Association predicts that the nursing profession in America will need around one million new nurses by 2022 due to various factors like an aging population and those with chronic illnesses.

Additionally, the top-paying states for registered nurses are:

• Massachusetts

All healthcare professionals need to know about this information because of how quickly technology is advancing in medicine, making these tools so much easier than ever before.

Informatics aims to improve patient care through education, research, health outcomes measurement, and clinical decision support systems (CDSS).

Benefits of Nursing Informatics

With the help of informatics, nurses and others in healthcare can stay at the top of their game.  This is especially important in a field that’s constantly changing. Informatics offers many benefits, including:

We maintain and improve the quality of care by making it easier to track both patient needs and data from across different providers.

Reducing errors through more accurate recording systems

Keeping up with changes in technology. Such as advances in medical devices or pharmaceuticals.

They are creating better information management practices for compliance purposes (including handling HIPAA).

All aspects of care delivery are based on evidence, including patient safety,  quality improvement initiatives, research compliance, and policy development.

Informatics can also help nurses locate state legislation concerning nursing issues like staffing ratios, competency requirements, and various licensing regulations.

Above are some of the essential benefits of why informatics matters so much to healthcare professionals today.

With the ever-growing digitization of healthcare, there is a need for nurses with in-depth knowledge and understanding of how to use technology. That’s why you have to learn why it is so important.

If you are interested in informatics or would like more information on this field, revisit our blog soon. We will have even more posts about informatics careers for nurses.

More Resources on Nursing Informatics:

• How to Get a Nursing Informatics Certification
• How to Get a Job in Nursing Informatics
• Health Informatics: Is Technology Improving Healthcare?
• Nursing Professional Development Week – Tips & Ideas

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Nursing Informatics Key Role in Defining Clinical Workflow, Increasing Efficiency and Improving Quality

COVID-19 has underscored the crucial role of nursing informatics as healthcare organizations have faced delivering care during these unprecedented times.

For decades, nursing informatics specialists have integrated nursing science with information and analytical sciences to identify, define, manage and communicate data, informatics, knowledge and wisdom. Nurse informaticists are now advancing their focus beyond EHR implementation and successfully innovating change as analysts, educators, software engineers, policy developers and operational owners to help advance healthcare.

During the pandemic, nursing informatics specialists have played a key role in establishing new clinical workflows, increasing operational efficiencies and improving care quality for their patients.

The HIMSS Nursing Informatics Workforce Survey indicates that over two-thirds (68%) of the survey respondents work for a hospital or multi-facility health system in an informatics role. Healthcare systems that have infused this nursing specialty into their healthcare workforce are well-positioned to navigate the challenges in expanding and applying new technologies to care for patients during the COVID-19 pandemic.

Clinical Workflows

Although telehealth was already in use in some healthcare systems, the COVID-19 pandemic accelerated the need for ambulatory and inpatient virtual care visit consults. In collaboration with program leaders, clinicians and information services, nurse informaticists—who understand the current practice in ambulatory and hospital clinical settings—have, in many cases, enabled health systems to accelerate telehealth solutions to keep patients and clinicians safe.

Nursing informatics specialists translate the virtual care technical and operational requirements, evaluate the core tools, develop project plans, and implement and support the system. Examples of new technologies and workflows implemented during COVID-19 have included solutions to schedule and virtually provide patient care. Further, some healthcare systems have deployed smart devices for person-to-person connective platforms in telehealth.

Operational Efficiencies

Nurse informaticists collaborate to define requirements, design, build, and implement workflow and technology solutions. Having informaticists as part of the team is beneficial for health system leaders and clinicians to promote the adoptions of new processes, as nurses are often natural change agents and can enable change management in a culture.

With their background and experience in patient care, nurse informaticists recognize the challenge and necessity of collecting meaningful data to properly deliver care. The specialty of nursing informatics has played a critical role in increasing operational efficiencies, especially in designing and building COVID-19-specific functionality in the EHR and other technology applications. For example, nurse informaticists are using their skills to streamline specific infectious disease history documentation for quicker triage. This has led to revamping documentation in EHRs and pre-screening patients before ambulatory on-site visits and entry to the hospital to proactively identify potentially infected patients and direct them to the appropriate care, as well as limit these patients from visiting our facilities for face-to-face appointments to protect patients, physicians, nurses and staff.

During the rapidly evolving COVID-19 pandemic, healthcare systems' efforts to stop the virus' spread and protect patients and employees are top priorities. Nurse informaticists assist in the deployment of telehealth and teleworking strategies for hospitals to maintain operations and keep people out of hospital facilities as much as possible. For instance, with executive leadership and informaticists on board to understand and define clinical workflows, errors and adverse events have been avoided—resulting in significant cost savings during the rapid negotiation and execution of telehealth solution contracts.

Quality of Care

During the COVID-19 pandemic, nurses are critical in delivering care and keeping patients and caregivers safe. With quickly developed technologies, nurse informaticists ensure that the essential tools are tested and assessed to mitigate telehealth's unintended consequences. Specifically, nurse informaticists uphold organizational privacy and security programs of applied telehealth technologies, adhere to HIPAA mandates, and ensure appropriate use of personal health information to meet evolving regulations.

Nursing informatics plays a critical role in implementing telehealth technologies designed to benefit patient-family and patient-clinician connected platforms in the inpatient setting. These technologies provide better patient experience with COVID-19 patients when family members are not allowed in patient care settings. Examples of telehealth technologies include implementing devices with video capability to provide human interaction, and conversational agent intelligence solutions such as voice-controlled virtual care assistants to further connectedness with patient care staff and family.

The specialty of nursing informatics has demonstrated its value for developing best practices and new processes in the fight against COVID-19. In this era of healthcare transformation, partnering with nurse informaticists benefits health systems in establishing new clinical workflows, increasing operational efficiencies and improving care quality.

The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

Online Journal of Nursing Informatics

Read Volume 26, Winter 2022

Updated April 20, 2021

There have been amazing advancements in healthcare technology over the past few decades, giving medical professionals access to more data with greater reliability than ever before. And with the evolution of informatics, nurses are able to leverage the information resulting from these scientific marvels to provide better care and treatment to patients.

Informatics has contributed to many innovations in healthcare delivery, including the adoption of digital health records, standardization of diagnostic information, simplified health insurance administration and improved patient privacy. Within the larger field of health informatics , nursing informatics uses data management and information technology approaches to improve patient care practices and prevent adverse health outcomes.

Because nurses make up the majority of direct care practitioners, they are in an ideal position to make an impact as specialized experts at the intersection of healthcare and technology. Registered nurses go beyond providing clinical care to take on roles in operations, education, leadership and technology in today’s healthcare system. Nursing informatics allows nurses to deliver evidence-based and patient-centered care, improve human health and advance medical research. It also enhances clinical workflows so that nurses and other personnel can care for patients more efficiently and effectively.

The History of Nursing Informatics in Healthcare

While nursing informatics is an essential component of care delivery today, there is a long tradition of innovative nurses using data to improve clinical practice and patient health. The history of nursing informatics dates back to the 1850s, when healthcare pioneer Florence Nightingale originated the practice by collecting, organizing and processing data to enhance sanitation via nursing and medical protocols. Nursing-specific engagement with information technology started a little over a century later, in the 1960s.

The following decade saw the first conference on nursing and computers, along with the international publication of nursing-specific informatics papers by American and British healthcare professionals. Then, in the 1980s and early 1990s, we saw such advancements as the creation of the International Medical Informatics Association (IMIA) Nursing Informatics working group and the practice-related activity of the International Council of Nurses (ICN). A U.S. newsletter called Computers in Nursing, which was the forerunner to the journal CIN: Computers, Informatics, Nursing was founded in 1983.

The formal establishment and definition of nursing informatics as a specialty practice by the American Nurses Association occurred in 1992, which was the same year that an official certification program for the field was created. Since then, there have been updates to the core content and requirements for certification to keep up with continually evolving theory, practice and technology. There have also been organized endeavors to advance informatics education and workforce training, one of the most notable of which was the TIGER (Technology Informatics Guiding Education Reform) Initiative in 2006.

The Benefits of Nursing Informatics

By driving the application of crucial healthcare technologies, nursing informatics has improved patient safety and facilitated developments that have revolutionized patient care, thus reducing the risk of adverse outcomes. For instance, electronic medical records (EMRs) have made it possible to keep patients’ complete medical and treatment history in digital form, giving nurses and other healthcare practitioners the ability to track data over time, see who is due for checkups or preventive screenings, monitor how patients are doing on health parameters like blood pressure and vaccinations and check and enhance quality of care in general within a practice.

The benefits of electronic health records (EHRs) are even more comprehensive, enabling nurses and doctors to do everything that EMRs allow them to do and much more. They transcend standard clinical data to concentrate on the total health of each patient. As such, they are designed to be shared among all of the person’s healthcare providers — nurses and physicians, laboratory technicians, specialists and others — to ensure coordinated, patient-focused care, and thus contain information collected by each of these professionals.

For example, with EHRs, data gathered by a patient’s primary care provider informs the emergency department clinician that the patient has a specific life-threatening allergy, enabling the clinician to adjust care appropriately, even if the patient is unconscious.

Informatics is also applied to the specific data within EHRs in order to better structure and organize that information so that large numbers of patients can be quickly identified and given the care they need. Dr. Matthew Solomon, a cardiologist at the Permanente Medical Group and a researcher at the Kaiser Permanente Division of Research in Oakland, California, worked with his team to develop and validate a software technology that could accomplish just that. Then, they applied it to their echocardiography database, which comprised almost a million reports from the past decade. Within a matter of minutes, the software identified nearly 54,000 patients with valvular heart disease, a process that would probably have taken physicians years to complete manually.

Another benefit of nursing informatics is that a nurse’s notes from a patient’s hospital stay can be used to create discharge instructions and a plan for follow-up care, allowing the individual to seamlessly transition from one care setting to another.

Additionally, the role of nursing informatics has improved patient safety by helping caregivers detect indicators of criminal abuse and protect victims. Nurses at John Peter Smith Hospital in Fort Worth, Texas developed and put into practice an algorithm for identifying intimate partner violence and evidence of human trafficking. The algorithm fits smoothly and efficiently into the emergency department (E.D.) nurse workflow, offers step-by-step directions to the nurses and includes a narrative to use in the event that the patient is determined to be a likely victim. Assistance is then provided to patients right away.

Nursing informatics improves safety by utilizing technology to facilitate the collection, analysis and reporting of higher-quality data related to patient safety issues and health outcomes, as well as to prevent medical errors and allow for better monitoring and reporting of those that do occur. Furthermore, informatics enables those in leadership roles, such as CNIOs, to design, develop and implement decision support tools; educate other nurses in the use of these resources; and employ predictive analytics tools to identify at-risk patients and population groups.

Nursing Informatics Careers

As nursing informatics plays an increasingly central role in hospitals and other healthcare organizations, experts are needed at every level to collect health information, process findings and communicate conclusions to clinicians and other stakeholders. From frontline practice to executive-level leadership, nurse informaticists significantly impact patient care and organizational efficiency.

Nurse Informaticist

Also known as an informatics nurse, a nurse informaticist oversees large sets of health data to advance nursing practice and population health. These nursing professionals play an important role in increasing efficiency, cutting costs and improving care by conducting research on topics affecting both caregivers and patients.

Some nurse informaticists practice as clinicians in addition to their technical job responsibilities, while others work as analysts and consultants. Security is always a top concern in the healthcare field, so nurse informaticists ensure compliance with laws and standards like the Health Insurance Portability and Accountability Act (HIPAA) and the Food and Drug Administration (FDA).

Other job responsibilities might include:

• Determining a healthcare organization’s needs and implementing technology that meets those requirements.
• Designing and delivering training on devices and applications to health practitioners and patients.
• Communicating key data findings to stakeholders to promote data-driven decision-making in processes and care plans.

Nursing Informatics Specialist

The job description for a nurse informaticist at the specialist level is mostly the same, and often includes clinical work in addition to technical responsibilities. But because the specialist role requires higher education levels, nurses with this title usually have more specialized skills, expanded responsibilities and higher earning potential.

Perioperative Informatics Nurse

A perioperative informatics nurse is a nurse informaticist specializing in caring for patients before, during and after surgical procedures, typically from the patient’s admission to the hospital or doctor’s office to their discharge. A perioperative informatics nurse also helps put new and expanded models of care into practice, improving the perioperative process. In addition to clinical work, they are involved on the research side of health information technology (HIT).

Chief Nursing Informatics Officer

A professional in this role is directly involved in administration, leadership and management within healthcare organizations. They work with other health leaders to develop technology solutions and lead critical initiatives related to health I.T. implementation, maintenance and optimization. The CNIO also represents the needs of nurses in strategic discussions with stakeholders like business partners and senior leadership.

This corporate collaboration extends to providing assessments and recommendations for emerging technologies and sharing best practices and insights to improve internal processes. Another key responsibility is evaluating whether clinical operations effectively meet the needs of patients and clinicians, then identifying areas for innovation and improvement.

The job description of a CNIO also includes:

• Developing and employing health data tools.
• Collecting, analyzing and reporting data related to safety issues and outcomes.
• Developing and overseeing policies and procedures for data analysis.

Become a Nurse Informaticist With the Right Education

Though all nurse informatics professionals are registered nurses, there are additional education requirements depending on the career path you want to pursue. For example, entry-level nurse informaticists usually have a bachelor’s degree in nursing or an associate degree in nursing combined with bachelor’s-level study in a relevant field like health information technology or data analytics.

To advance in the field as a specialist, you will need graduate-level education in informatics or a related area. And to become an executive or director in nursing informatics, you will likely need to hold a master’s degree in nursing (MSN) or nursing informatics – some candidates even have a doctorate in nursing or a PhD. Continued education puts these roles within reach for registered nurses interested in this growing and essential practice area.

Healthcare information technology (HIT) and patient care are constantly evolving, providing ample opportunities for working nurses to advance in the field and expand their skill sets. Carlow University’s Dual Master of Science in Nursing in Education and Leadership and Master of Business Administration (MSN – MBA) degree program will prepare you for success in nursing informatics as an adept and knowledgeable healthcare provider, HIT professional and business leader.

Further your career in a flexible online format designed with the working student in mind. Learn from qualified instructors who possess real-world experience and give you the same dedicated, specialized attention as on-campus students. Our program features a warm, welcoming and supportive community that fosters personal and professional growth.

To learn more about the practice and role of nursing informatics in healthcare and begin the next stage of your education journey, call 1 -855-511-6450 , email [email protected] or fill out the form located here .

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Benefits of Informatics in Nursing

Hospitals and organizations across the healthcare continuum have adopted increasingly sophisticated health information technology to record patient data and guide clinical decision making. Specialists in nursing informatics harness these sophisticated applications to support crucial duties like performing diagnostics, developing care plans, administering treatments, and educating patients and their families. Healthcare providers can now access an unprecedented volume of quantitative information that makes it possible to assess the needs of patients more accurately.

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What Is Informatics in Nursing?

Healthcare informatics is a discipline focused on the management of electronic health records and information systems . Equipped with up-to-date information technology, medical facilities and life sciences businesses fulfill the technical requirements to securely handle enormous amounts of sensitive data.

The resulting insights can keep facilities running at their best and guide leadership toward long-term improvements. Healthcare informaticists may uncover findings that serve to prevent the spread of disease in a population, promote treatment adherence, coordinate care among multiple specialists and ensure an organization’s compliance with all relevant privacy regulations and policies. However, each of the many roles that keep a healthcare organization functioning, from doctors to administrators, may benefit most from different types of quantitative information and varied approaches to organization, analysis and visualization.

Nursing health informatics strives to facilitate the unique job responsibilities of nurses through optimized health IT methods and software tools and nursing informatics technology.

What does a nurse informaticist do?

Specialists known as nurse informaticists may apply their skills to:

• Develop data structures and software tools for nurses to use
• Keep electronic health records aligned with best practices for data management, processing and organization
• Implement analytics to monitor and facilitate nursing processes
• Enable healthcare and IT professionals to communicate with each other more effectively
• Develop and enforce privacy policies in accordance with ethics and regulations
• Educate providers in how to make the best use of electronic health records and clinical decision support systems

Nurses who build the skills to solve problems through technology and quantitative analysis can succeed in nursing informatics careers. These professionals commonly hold job titles such as:

• Chief Medical/Nursing Information Officer
• Clinical Informatics Analyst
• Clinical Informatics Nurse
• Clinical Informatics Specialist
• Nursing Informatics Specialist or Nurse Informaticist
• Nursing Information Systems Coordinator

Benefits of Nursing Informatics in Healthcare

The findings garnered from health IT systems, electronic health records and software tools can not only assist in nurses’ daily tasks but fuel transformation throughout a healthcare organization. Informatics professionals investigate data to find powerful means of helping providers fulfill their duties and collaborate across multiple disciplines. Adelphi University’s Department Chair of Graduate Nursing Studies Edmund J.Y. Pajarillo suggested that shifts over the next decade may have widespread effects on the nursing profession.

“Technology is causing sweeping changes so that the traditional roles of nurses might become outdated,” Pajarillo said.

By embracing the possibilities of informatics in nursing, nurses and other healthcare professionals can position themselves ahead of the curve. Some of the most promising effects from the advent of informatics-driven strategies in nursing include superior patient outcomes, more efficient clinical processes, more collaborative and coordinated care, and advances in telehealth.

Superior Results for Patients

Accurate and thorough electronic health records are essential to high-quality treatment . Informaticians ensure that organizations have the platforms and processes in place to document each patient’s condition and history in depth while complying with privacy regulations. Digital connections place extensive biometrics and pharmacy records at nurses’ fingertips so they can plan interventions and share the relevant findings with various departments.

Nursing staff use informatics solutions to identify patients who are at higher risk for serious conditions and take preventative steps early. Automated alerts minimize the chance for medical errors by warning providers about potential dangers such as a patient’s allergy or a hazardous drug interaction.

Efficient Clinical Processes

For years, healthcare organizations have pursued a shift away from a fee-for-service model into providing value-based care. Informatics aids in these efforts to offer systematic, evidence-based treatment that prevents unnecessary or overly expensive procedures. By examining analytics, leaders are able to set and enforce best practices while meeting the individual needs of each patient.

Clinical decision support systems are a powerful means of harnessing data from electronic records and ubiquitous medical devices to standardize care and eliminate waste. Information science professionals implement these software programs to analyze patient data and offer useful information like clinical guidelines. A decision support system may help make diagnoses as well as trigger timely prompts and reminders over the course of treatment.

Coordinated Care

Delivering the best possible results for patients often calls for collaboration among healthcare professionals who may work in different departments, facilities or organizations. Care coordination and communication makes it possible for everyone involved in diagnosis and treatment to organize their efforts and share information.

According to the New England Journal of Medicine , the key elements involved in care coordination are :

• Access to a variety of healthcare services and providers
• Clear communications and effective planning among the providers
• A holistic approach to a patient’s medical needs
• Information shared with patients in terms they can understand

Digital infrastructure is crucial to making the most of these efforts. When nurses, specialists and other providers easily access details about a patient’s needs, they can make more informed decisions and prioritize safety. With extensive security measures and privacy practices in place, professionals can share the necessary health records to ensure they offer the best treatment and avoid redundant procedures.

Advances in Telehealth

Dr. A. Hasan Sapci, an assistant professor of health informatics at Adelphi, thinks the recent progress toward widespread adoption of telemedicine devices and practices is just beginning. He argues that the growing use of digital sensors to monitor the conditions of patients is a sign of a major shift in how healthcare providers track diseases, encourage treatment adherence and prevent dangerous situations.

“Digital monitoring applications are now breaking into the mainstream,” Sapci said.

Adelphi’s College of Nursing and Public Health accordingly emphasizes the growing importance of telehealth in the informatics curriculum . Sapci established the Smart Home for Home Healthcare Lab, which provides hands-on experience using the latest technology to monitor patients outside of a traditional hospital or medical practice. Students experiment with remote sensors, telepresence appointments and applications to gain insights into an individual’s health from a distance.

How Do You Become a Nursing Informatics Specialist?

Nursing informatics careers require specialized expertise in both nursing and information science. Professionals in this field generally have previous nursing experience, and, according to data from Lightcast , job postings for registered nurses are among the top five occupations to request familiarity with healthcare informatics. However, healthcare informaticists with backgrounds in data analysis, information science, computer science or other related fields may also be able to pursue careers in developing technical solutions to help nurses.

To excel as a nursing informaticist, you need an advanced understanding of how data and systematic processes can achieve immediate improvements and lead an organization toward its long-term goals. Graduate education in the field equips nurses and supporting IT staff with the knowledge they need to become effective quantitative problem solvers. The Department of Labor found that 41 percent of the roles in nursing informatics require a master’s degree.

You can prepare for the quantitative problem solving and healthcare challenges involved in these roles by following a nursing informatics education pathway like the following:

Starting a Career in Informatics: How To Get Into Nursing Informatics

• Earn a Bachelor of Science in Nursing and become licensed as a registered nurse .
• Pursue a Master of Science in Healthcare Informatics .
• Gain first-hand experience in the nursing informatics field by completing a practicum.
• Take an exam and meet all other requirements for board certification in Informatics Nursing from the American Nurses Credentialing Center.

A healthcare informatics master’s program provides students from a variety of backgrounds with specialized skills in implementing electronic systems for medical records, analyzing data to improve care and capturing the potential of remote monitoring systems. By becoming an expert in the data that nurses use every day, you can tackle complex challenges and enhance the well-being of countless patients.

About Adelphi’s Online MS in Healthcare Informatics

The online Master of Science in Healthcare Informatics from Adelphi University’s College of Nursing and Public Health prepares students for careers in implementing cutting-edge medical technologies to meet the needs of patients and healthcare professionals. This degree program is an excellent fit for practicing nurses and doctors, health IT professionals as well as career changers. No matter your experience level or background, Adelphi provides multiple layers of support, especially for those who may have been out of school for a while. In addition, Adelphi offers an online Advanced Certificate in Healthcare Informatics which provides working professionals the opportunity to earn an advanced certificate in as little as 15 months.

The master’s in healthcare informatics program has received accreditation from the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) —making it the first program to be accredited in New York state. This accreditation underscores our commitment to the highest academic standards and excellence in health informatics education. Our expert faculty offer personalized instruction in convenient online courses that are informed by years of professional experience. The healthcare informatics curriculum is designed to help working professionals transform healthcare management and delivery. Hands-on exercises and a comprehensive education in health information technology, will develop your proficiency in working with electronic medical records and the systems that are critical to improving patient care.

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An Overview of Nursing Informatics (NI) as a Profession: How we Evolved Over the Years

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7 Benefits of Nursing Informatics in Healthcare

Pretend for a moment that nursing informatics doesn’t exist. in its place, we have … well, nothing.

Yes, we still have nurses, and yes, we still have computers. And Electronic Health Record (EHR) systems and Meaningful Use incentives and cloud computing.

And of course, we have a lot of unhappy clinicians, driven to flammable frustration by inefficient computer systems that force them away from the patient’s bedside to the keyboard, mouse, and screen.

Well, as fate would have it, one day you’re driving home and recalling that study about ICU patients and the amount of time a clinician is in their room. A physician is there 13 percent of the time. Critical support staff is there eight percent of the time.

But nurses! Whenever there’s at least one health care worker in the room, a nurse is there 86 percent of the time!

Inspiration hits you. Nurses are the answer.

Nurses spend a LOT of time with patients. Nurses know patient care. Nurses work with the EHR. They possess deep experience with EHR workflows and forms and documentation processes … and they suffer just like everyone else with the clumsy interface and workflows. Goodness, it’s as if all the computer systems were designed entirely by computer geeks. Smart programmers, but they don’t understand healthcare workflows.

But the nursing profession. THAT’S the answer, you realize. Nurses can bridge the gap between health delivery and powerful technology systems.

So you invent nursing informatics, become a national hero, and are the featured star at the next Super Bowl halftime show.

What is Nursing Informatics?

The American Nurses Association describes nursing informatics as “the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice.”

And in reality, nurses were the heroes. They recognized the potential of computerized systems and formed the Capital Area Roundtable on Informatics in Nursing (CARING) in 1982 “to provide a forum for the advancement of automated healthcare information systems.”

In those early days, you couldn’t find a college of nursing with a program in informatics. Instead, nurses who had clinical experience, along with interest and skills in computer science, simply looked for ways to improve clinical care through information and automatic processes.

Information + Automatic Processes = Informatics

Today, it’s easy for RNs to find nursing programs that offer masters and doctoral degrees in nursing informatics. However, it’s still common for RNs to becoming informaticists without formal education in the specialty. With or without the degree, the last decade’s surge in EHR implementations increased the need for tech-savvy nurses who can help research, evaluate, design, develop, and test clinical information systems. Their work provides valuable decision-making support to patients, their families, and their healthcare providers.

The key to success in nursing informatics is the background in nursing. A recent HIMSS report shows that nearly 60 percent of nurses had over ten years of bedside clinical experience before becoming an informaticist.

What does a Nurse Informaticist do?

The HIMSS Nursing Informatics Workforce Survey gives us a sense for the general duties of a nurse informaticist:

But there’s much more value to nursing informatics than a dry bar chart can portray.

In short, nurse informaticists are a remarkable gift to society.

Because in nursing informatics, we start with a group of people who want to take care of us when we are our most physically vulnerable – even when it gets messy.

In addition to their active compassion, we add the knack for analyzing patient records and workflows, then finding ways to achieve desired health outcomes more efficiently and effectively.

Next, we add technical skills for using, evaluating, designing, and building computer systems.

Finally, we top it off with an ability to apply their integrated clinical and technical wisdom to training, educating, and guiding a wide range of people:

• Patients and their families
• Other clinicians at all levels
• Computer programmers
• Administrators and organizational leadership
• Compliance professionals
• Policy professionals

Now, consider the last three ingredients we discussed:

• Data analysis for the purpose of improving efficiency
• Technical skills for developing computer systems
• Communication skills

Someone with these abilities can still improve our healthcare system by working in the more generalized field of health informatics.

But the person whose first passion is nursing, and who then acquires and develops the other three skills? That person bridges the gap between the technical and clinical worlds and is indispensable for helping the healthcare industry create superior computer systems that support the best workflows and decision-making around patient care, communication, and documentation.

So to repeat: Nurse informaticists are a remarkable gift to society.

Let’s look at seven benefits of nursing informatics.

Benefit #1: Nursing Informatics informs and influences IT systems

As seen in the “Job Responsibilities” chart above, nursing informatics specialists spend much of their time helping to develop, implement, and optimize computerized patient information systems. It’s their blend of clinical and technical knowledge and experience that makes them perfect liaisons between the clinical and technical communities.

One of the early contributions of nursing informatics was to help move healthcare away from paper forms and into electronic documentation. Today, a nurse’s standardized notes are immediately available to physicians and other caregivers through EHR systems. Workflows and decisions are more informed and efficient.

Many EHR vendors recognized the value of hiring nurse informaticists to help design and build their system. In short, these EHR vendors acquired a double-barreled secret weapon because nurse informaticists:

• Recommend the most practical layout for forms and reports, and the best processes for electronic medication administration.
• Prevent EHR mutiny because they can predict clinician reactions to technically efficient – but clinically clumsy – workflows, and shape EHRs that avoid these poor workflows.

Here’s another way to look at it: Nursing informatics specialists are trilingual.

• They understand the clinical language of efficient patient care.
• They translate knowledge and clinician feedback into the technical language of business analysts and programmers.
• They communicate clinical and technical matters with administrative leadership.

It’s not simple to speak effectively with clinical, technical, and administrative people. Still, nursing informatics specialists are qualified and have proven to be indispensable to the development of superior healthcare IT systems.

“Informatics professionals with a nursing background combine the best of both worlds: deep expertise in clinical care helps nurse informaticists understand the needs and stresses of the clinical workflow, while their education and background with information technology systems and data analytics helps them sculpt health IT infrastructure into a meaningful and helpful tool.” – Health IT Analytics

Benefit #2: Nursing Informatics leverages evidence-based clinical best practices

Most clinicians want to apply their knowledge and experience to improve patient care. The nurse informaticist takes it a few steps further by:

• Researching clinical nursing practices outside of their own experiences.
• Finding evidence to prove which clinical practices are best.
• Influencing the design of clinical systems to support and promote the best evidence-based practices and workflows (see Benefit #1).
• Training other nurses to use clinical IT systems (see Benefit #3).

Benefit #3: Nursing Informatics generates stronger nurse training in clinical IT systems

Clinical IT systems are complicated, and their interfaces and workflows are not always intuitive.

But nursing informatics specialists are well-suited to teach other nurses how to get the full benefits of these systems.

Because in some cases, nurse informaticists helped design and create those very systems. But at the very least, they understand the reasons, from a nursing care perspective, for the structure of each digital form and each sequence of clicks. They can explain built-in interoperability and behind-the-scenes interfaces to other clinical systems in language that’s easily understood by nurses.

Benefit #4: Nursing Informatics leverages IT investments

Every health facility – from the single-physician practice to the large academic medical center – invests a significant amount of their budget on essential health information technology products and services. These include patient care systems like the PACS and electronic medical records system, communication technologies like pagers and secure messaging systems, and analytics tools.

Nurse informaticists help get maximum value from these investments in at least three ways:

• They ensure that systems are designed to support effective patient care workflows (see Benefit #1).
• They help train other nurses to use IT efficiently (see Benefit #3).
• They apply advanced analytics strategies to develop predictive models.

As an example of predictive models, consider Texas Health Resources in Dallas-Fort Worth. Their informatics nurses use analytics tools to identify the risk of sepsis, risk of readmission, and potential benefit from palliative care.

Benefit #5: Nursing informatics contributes unique wisdom to clinical care that is acquired only through a deep understanding of both clinical practice and data analysis

Let’s hear from Gina Wade, an informatics nurse specialist, to see how their distinct blend of clinical and data knowledge equips them to offer valuable insight and guidance to the healthcare system .

“Informatics nurse specialists work with leadership regarding regulatory and quality initiatives – and governance for technology implementation and change. For example, we work with the delivery-of-care team – the chief nursing officer, chief medical officer, and quality leadership – who might give us a directive based on improving patient safety by decreasing readmissions.

“We’ll identify the key areas where studies tell us problems arise: inadequate discharge education, a patient doesn’t have support at home, poor hearing or sight, or being on multiple medications. We’ll take those variables and identify how and wherein the system we should alert a nurse that this is a possible red flag and give her the elements of a plan to decrease the risk for a readmit. We explain to the technical and application team what we need the system to do. They build it, and we validate the build. Then we go back to clinical leadership and demonstrate what was designed and built.”

Because nurse informaticists understand data analysis and nursing practice, they immediately know which trends are worth analyzing and which anomalies are significant enough to escalate.

Benefit #6: Nursing Informatics enriches the evolving healthcare delivery system

Advances in healthcare technology launch new options for healthcare delivery, and nurse informatics specialists are helping ensure these new options are beneficial to both patients and clinicians.

Two examples are developments in communication technology and remote healthcare, known as telehealth.

Regarding communication technology, vendors are using Smartphones to transform the way communication in nursing happens. Advanced applications – from secure messaging to EHR integrations that push critical results to a physician’s phone just seconds after the results hit the EHR – are dramatically improving the efficiency of healthcare delivery.

Regarding the growing field of telehealth, patients are receiving education and self-management training, automatically storing and forwarding medical data, and seeing their providers – from the other side of town, or the other side of the world. And nurse informatics specialists are helping design and implement telehealth systems , as well as training their fellow nurses in how best to use the systems.

Benefit #7: Nursing Informatics Improves Patient Care, Patient Safety, and Outcomes

The more generalized field of healthcare informatics focuses mainly on administrative issues, whereas nursing informatics focuses on patient care.

In fact, the substance of the first six benefits of nursing informatics is all about improving care, safety, and outcomes for patients. The nurse informaticists resume is like an endowment to patients and their families:

• More efficient electronic health records
• Better IT systems
• Research and application of clinical best practices
• Training of other nurses
• Analytics-based predictive models
• New avenues for patient education
• Support for telehealth technology

And how do patients benefit from nursing informatics?

• Fewer medical errors
• More informed clinical decision-making
• Shorter hospital length of stay
• Lower admission and readmission rates
• Better self-management

We’ve looked at seven benefits of nursing informatics. Along the way, we tried to hint at a healthcare system without nursing informatics. We’d manage, surely. But our healthcare system is much better off with nurse informaticists doing their thing, being a remarkable gift to society.

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The Evolution of Definitions for Nursing Informatics

Nancy staggers.

Affiliation of the authors: University of Utah, Salt Lake City (NS); University of Nebraska, Omaha (CBT).

Cheryl Bagley Thompson

Despite the fact that nursing informatics is entering its third decade as a specialty within nursing, many definitions still exist to describe the field. This paper offers a rationale for a definition for nursing informatics and a critical analysis of past definitions. An organizing framework of technology-oriented, conceptual, and role-oriented definitions is used to critique these definitions. Subsequently, a revised definition is proposed. This evolutionary definition integrates critical concepts from past work and adds components that are currently missing—patients, information communication, information structures, and decision making. A separate role specification for informatics nurse specialists is provided.

Despite the fact that nursing informatics is entering its third decade as a specialty, many definitions still exist to describe the field. 1, 2 In fact, authors have directed substantial efforts toward creating definitions for the specialty over the years. 3– 6 As a consequence, informatics practice and education have often proceeded without consensus about this fundamental element.

This paper offers a critical analysis of the evolution of major nursing informatics definitions. It also presents a revised definition of nursing informatics and a role specification for the informatics nurse specialist. Portions of an early draft of this paper were incorporated into the work by an American Nurses Association expert panel, which assumed the task of revising the scope of and standards of practice for nursing informatics in the United States.

The Need for a Definition of Nursing Informatics

“Medical informatics” is used as an overarching term both to describe any informatics efforts related to health care and also to describe a distinct specialty in the discipline of medicine. Consensus has not been reached about whether medical informatics, especially as the term is used in medicine, is the same discipline as what might more broadly be called health informatics. 7, 8 Similarly, a lively debate in the literature underscores the disagreement about whether nursing informatics and medical informatics are separate disciplines. 7

Regardless of the outcome of this debate external to nursing, nursing informatics is considered a distinct specialty within nursing. If for no other reason than that, a definition for nursing informatics is important for other nurses and for informatics nurse specialists, the label adopted by the ANA, 9 because informatics nurse specialists need to be able to succinctly define their practice.

A definition is a fundamental element for shaping a specialty. A definition for nursing informatics guides role delineation for nurses interested in informatics and suggests directions for practice, education, training, and research. Also, a definition is one foundational element of national scope documents for the nursing informatics specialty. In particular, a national definition is used by funding agencies, such as the Division of Nursing in the Department of Health and Human Services and the National Institute for Nursing Research, to define projects and allocate monies to nursing informatics efforts.

Furthermore, a definition of nursing informatics may be useful to other disciplines as they define informatics practice within their own specialties. Finally, a definition for nursing informatics is needed to help others, within and outside nursing, understand the legitimacy of the practice and the general competencies of a nurse who specializes in informatics.

Definitions of Nursing Informatics

The authors reviewed work on definitions for nursing informatics. Other authors than those considered here have published important work related to facets of nursing informatics, such as defining requirements, designing nursing systems, 10– 12 and nurse– computer interaction. 13 However, the focus of this analysis is on overarching definitions for the nursing informatics domain. A review of definitions of nursing informatics makes apparent three themes for analysis (revised from those suggested by Turley 2 )—information technology–oriented, conceptually oriented, and role-oriented definitions.

Information Technology–oriented Definitions

The earliest series of definitions for nursing informatics highlighted the role of technology for what was a new specialty in nursing. An early definition by Scholes and Barber 6 stated that nursing informatics was “the application of computer technology to all fields of nursing—nursing service, nurse education, and nursing research.” Ball and Hannah 3 modified an early definition of medical informatics, acknowledging that all health care professionals are part of medical informatics. Therefore, nursing informatics was “those collected informational technologies which concern themselves with the patient care decision-making process performed by health care practitioners.” Shortly after this, Hannah 14 continued the emphasis on technology and added the concept of the nursing role within nursing informatics:

The use of information technologies in relation to those functions within the purview of nursing, and that are carried out by nurses when performing their duties. Therefore, any use of information technologies by nurses in relation to the care of their patients, the administration of health care facilities, or the educational preparation of individuals to practice the discipline is considered nursing informatics.

Saba and McCormick 15 centered their first book on the notion of technology by outlining chapters related to “nursing information systems” and computer applications in the four areas of nursing. While the term “nursing informatics” did not appear in this book, the authors defined nursing information systems as systems that use computers to process nursing data into information to support all types of nursing activities or functions.

The emphasis on technology is not limited to early definitions. Zielstorff et al. 16 also supported technology's significance in nursing informatics. More recently, Hannah et al. 17 and Saba and McCormick 5 continue to stress the role of technology in nursing informatics as it supports the functions of nursing. Hannah et al. continued with their original definition for nursing informatics, and Saba and McCormick provided this new definition:

The use of technology and/or a computer system to collect, store, process, display, retrieve, and communicate timely data and information in and across health care facilities that administer nursing services and resources, manage the delivery of patient and nursing care, link research resources and findings to nursing practice, and apply educational resources to nursing education. 5

All these authors make a salient point about the principal role that technology plays in informatics. For institutions installing clinical systems, technology can even seem to dominate all other issues during implementation. Some authors 17 even argue that technology has been the primary driver of clinical processes, rather than the other way around.

The information technology–oriented view of nursing informatics may be critiqued for overstating the role of technology and underemphasizing the need for the informatics nurse specialist to support the cognitive interaction between the nurse, the nursing process, nursing data, patients and the technology. More important, emphasizing technology discounts the fact that informatics does not require the aid of a computer or other technology. 8 Examples include reorganizing data presentation in a paper document to increase its information content, developing taxonomies to increase data sharing across sites, and conducting research related to the nursing minimum data set. These are essential informatics activities that are not centered on computer technology.

The technology-oriented definitions do not easily suggest the informatics functions a nurse might assume in a health care organization apart from the nurse's role in patient care. Specifically, informatics theories, principles, methods, and tools are not evident. These activities include, in part, needs analysis, requirements determination, structured system analysis, design, selection, implementation, and evaluation.

Although patients were mentioned by a few authors in technology-oriented definitions, the role of patients implicit in these early definitions was as more passive receivers of nursing care rather than as active partners involved in decisions related to their own care. Even this notion of the passive role of patients dropped from visibility in later nursing informatics definitions.

During the years since nursing informatics began, the role of patients in health care and in informatics has expanded greatly. It is common knowledge now that the Internet provides patients with an unparalleled amount of information about health, and the use of computers by patients in the home is more ordinary. 19 Past definitions were constructed with patients as implicit rather than explicit players in health computing.

Conceptually Oriented Definitions

A shift from technology-focused definitions to more conceptually oriented definitions began during the mid 1980s. However, this approach did not gain acceptance until nearly 1990.

Schwirian. Schwirian 20 moved away from technology and stressed the need for a “solid foundation of nursing informatics knowledge [that] should have focus, direction, and cumulative properties.” She emphasized the need for informatics research to be “proactive and model-driven rather than reactive and problem-driven.”

Schwirian cited Hannah's 14 more technology-oriented definition of nursing informatics but produced a model that expanded thinking about the definition of nursing informatics beyond just a focus on technology. Her research model outlined a pyramid of users, nursing-related information, goals, and computers (hardware and software) interconnected with bidirectional arrows. Nursing informatics activity lies in the intersection of the other elements.

Meant as a stimulus for research in nursing informatics, the model could have been used to guide thinking about nursing informatics definition and practice as well. As was typical of earlier definitions, the roles of patients, nurse informatics specialists, and theories, concepts, methods, and tools are not made explicit. However, the model depicted the inter-relationships among interacting components and included new concepts of nursing-related information, goals, and context. Schwirian's emphasis on research was prescient, given the role research currently plays in informatics.

Graves and Corcoran. Graves and Corcoran 4 provided the first widely cited definition downplaying the role of technology and incorporating a more conceptually oriented viewpoint:

A combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care. 4

This definition broadened the horizon from technology and placed nursing informatics firmly within the practice of nursing. It also provided the first acknowledgment in nursing of an information-knowledge link, using concepts borrowed from Blois, 21 and provided the foundation for Graves' work in knowledge building in the Sigma Theta Tau library.

Graves and Corcoran discussed the need to understand “how clinical nurses structure clinical problems and how they ask questions of the information system.” These views drew researchers involved in the study of decision making under the rubric of nursing informatics. In addition, these views accented the need to consider the clinical decision-making process in the design of information systems. With an understanding of how captured data are used in decision making, designers can create systems that better meet the needs of nurses during their clinical decision-making processes. Graves and Corcoran's definition allowed a concentration on the purpose of technology rather than on the technology itself. Their transformation of the definition for nursing informatics changed the focus from technology to information concepts by expressly incorporating information science.

Graves and Corcoran's emphasis on nursing data, information, and knowledge was a novel change in direction in the late 1980s, and others immediately adopted the definition. The conceptual aspects of this definition of nursing informatics have been incorporated into many authors' works, including a review of the state of the science of nursing informatics by Henry 22 and the National Institute of Nursing research priorities. 23 Other authors supported this theme by stating that the main issues in nursing informatics are conceptual and information-related 24– 29 or by building on the initial work of Graves and Corcoran. 4, 22 In fact, Henry's review of the state of the science in nursing informatics 22 is organized using the concepts of nursing data, information, and knowledge.

One reason for the extensive acceptance of this new approach may have been that managing information (i.e., data, information, and knowledge processing) is at the core of nursing practice with or without technology. Therefore, the heart of the Graves and Corcoran definition 4 resonated with practitioners, and an immediate connection was established between nursing practice and nursing informatics. The centrality of nursing practice in the Graves and Corcoran definition also supported the need for nursing informatics as a distinct specialty within health informatics. Although informatics nurse specialists use many of the same tools and processes as practitioners in other areas of informatics, the data, information, and knowledge have elements unique to nursing.

The 1989 paper by Graves and Corcoran 4 contrasted with their earlier work on the “Design of Nursing Information Systems.” 30 The earlier paper placed the concepts of nursing data, decisions, and processes in a theoretical model showing the flow of data, information, and knowledge and the relationships among these key nursing processes. The model described how both research and clinical decision making affect patient care and serve to build domain knowledge. In the earlier paper, 30 Graves and Corcoran identified how information technology could be used to facilitate each of the identified processes and transformations.

By changing their focus from this model in their second paper, 4 Graves and Corcoran in effect narrowed the definition of nursing informatics, from the entire framework of nursing practice to the conceptual movement of data, information, and knowledge. This movement shifted the emphasis away from technology but also removed the context of nursing and de-emphasized the interrelationships among technology, nurse, and patients.

Turley. Turley 2 analyzed previous nursing informatics definitions and then proposed a new nursing informatics model. Although he did not propose a new definition 1 in this paper, by focusing on model development, he continued a conceptual approach to the definition of nursing informatics.

Turley's major contribution was the addition of cognitive science to a model comprising the original three sciences proposed by Graves and Corcoran. 4 Cognitive science includes such topics as memory, problem solving, mental models, skill acquisition, language processing, and visual attention. 2 These concepts can help informatics nurse specialists understand the decision-making and information processing done by nurses and, subsequently, assist in the creation appropriate tools to support nursing processes. Therefore, cognitive science is most helpful to informatics nurse specialists concentrating on informatics issues related to users, such as decision making and the construction of computer interfaces for nurses.

Although cognitive science is certainly a useful cognate for nursing informatics, the addition of a single science to a model may give prominence to one cognate and underplay the need for multiple cognates to support nursing informatics. For instance, if innovation diffusion is studied, the pertinence of cognitive science may fade in comparison with organizational politics. Turley's work represents a conceptual framework for the nursing informatics specialty and suggests that cognitive science should be added to the three core sciences included in definition of nursing informatics by Graves and Corcoran. 4

Role-oriented Definitions

In the late 1980s, informatics nurse specialists were becoming more prevalent. Individuals were bootstrapping themselves into jobs related primarily to the insertion of computer technology into health care settings. The early information technology definitions suited these individuals, because the definitions emphasized the technology aspects of their job descriptions. Also, chief information officers at many institutions were most interested in persons who had a focus on technology.

As nursing informatics gained recognition as a nursing specialty, the Council of Computer Applications in Nursing, of the American Nurses Association (ANA), 31 provided a new definition for the field. The ANA expanded the previous definitions by incorporating the role of the informatics nurse specialist into the earlier Graves and Corcoran definition 4 :

A specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, and research and to expand nursing knowledge. The purpose of nursing informatics is to analyze information requirements; design, implement and evaluate information systems and data structures that support nursing; and identify and apply computer technologies for nursing. 31

The second sentence addresses concepts that represent the life cycle of information systems, more commonly called the “systems life cycle.” This particular definition represents the first time concepts from an informatics method, the systems life cycle, appear in a definition.

While this one tool is important to informatics nurse specialists, other tools are as well. Why this one tool was singled out is not specified. In fact, informatics nurse specialists employ a variety of informatics theories, principles, methods, and tools. In the end, however, this particular ANA definition was not been frequently cited, as is evident in later informatics work. 2, 5, 22

In 1994, the ANA modified their definition in an effort to legitimize the specialty and guide efforts to create a certification examination:

Nursing informatics is the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and expansion of nursing knowledge. It supports the practice of all nursing specialties, in all sites and settings, whether at the basic or advanced level. The practice includes the development of applications, tools, processes, and structures that assist nurses with the management of data in taking care of patients or in supporting their practice of nursing. 32

Although the 1994 ANA definition continued to provide information on the role of the informatics nurse specialist, the concepts from the systems life cycle were replaced with a more generic discussion of the role of the informatics nurse specialist.

The early theoretic work of nursing informatics concentrated on three general themes—information technology, conceptual foundations, and the role of the informatics nurse specialist. The more technology-oriented definitions were a reflection of their era, and the definitions matched the task at hand. Schwirian's early work on a conceptual definition 20 was largely ignored as practical issues rather than more theoretic work guided definitions.

As informatics became more integral to the practice of health care, formal programs of education were developed, and the specialty sought more conceptual definitions and models to underpin curricular development. Graves and Corcoran 4 answered this need, and their thoughts became central to many authors' works. Their 1989 work 4 narrowed the focus from the broader conceptualization of nursing informatics given in 1988 30 to the core concepts of managing and processing nursing data, information, and knowledge. Yet, it is the broader conceptualization outlined in the earlier Graves and Corcoran article that served as the foundation for nursing informatics curricular development at the University of Utah. 33

As the specialty expanded in a complex practice arena, both technology-oriented and conceptual themes were deemed pertinent to nursing informatics. The ANA 31, 32 offered a blend of these somewhat differing positions and added concepts related to the role of the informatics nurse specialist. These definitions first acknowledged the role of informatics nurse specialists and chose, from the suite of possible concepts, theories, and methods available to informatics nurse specialists, a single informatics method, the systems life cycle, as integral.

The evolution of definitions for the specialty of nursing informatics will undoubtedly continue into the near future at least. Endeavors directed toward refining the definition of nursing informatics should address the following issues.

First, even in this amalgam of definitions, the role of patients is underemphasized. As technology has become more widely available, patients are taking a more active role in their health care. Therefore, definitions of nursing informatics will need to consider this increased involvement in a refinement of a definition for the specialty.

Second, in the clinical setting, nurses are information integrators at the patient level. This close connection between nurse and patient in clinical settings has not been evident in past definitions, and the role of the nurse as information integrator has not been explicated. The role of nurses as they integrate data from and communicate data to other providers, such as other nurses, physicians and pharmacists, has not been highlighted. In a revised definition, nurses should be identified as information integrators among patients and other providers.

Third, other salient elements and their inter-relationships need to be addressed in a revised definition—support for decision making by nurses, technology, and context.

Fourth, the role of knowledge building through research is essential to include. This acknowledgment would begin to address the critical role of informatics research in current endeavors, such as evidenced-based practice, genomics, and neuroscience.

Finally, a new definition needs to consider pertinent theories, concepts, tools, and structures that are useful to the informatics nurse specialist—information structures (taxonomies and other meaningful organization of information), information technology, and the communication of information.

A Revised Definition of Nursing Informatics

From this analysis, it is clear that continued refinement of a definition of nursing informatics is required as the specialty of nursing informatics matures. However, a careful evolution of definitions is needed. There is danger in piecing together definitions from various fragments of work. For instance, if new definitions are created piecemeal and curricula are based on these pieces, resulting definitions and programs may end up being a collection of “hot topics.”

Therefore, the previous analysis of the historical foundations of definitions of nursing informatics has been used to develop a revised definition. The revised definition for nursing informatics acknowledges the expanded role of patients in their own health care, the role of the informatics nurse specialist, the broad concepts of nursing and nursing informatics, and the inter-relationship of critical elements within nursing informatics.

The revised definition is as follows:

Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics 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, information processes, and information technology.

Beyond the definition, the goal of nursing informatics is to improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of information and technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering educational experiences, in supporting lifelong learning, and in supporting nursing research.

A formal specification of the role of the informatics nurse specialist is also offered. A separation of role from definition may provide stability for the definition of nursing informatics, as the practice component is more susceptible to change in rapidly evolving technology and health care environments. The role of the informatics nurse specialist is:

To employ informatics theories, concepts, methods, and tools to analyze information and information system requirements; design, select, implement, and evaluate information systems, data structures, and decision-support mechanisms that support patients, nurses, and their human–computer interactions within health care contexts; and to facilitate the creation of new nursing knowledge.

This paper provides a critical analysis of definitions for nursing informatics. Three organizing elements form the structure for analysis—technology-oriented definitions, conceptually oriented definitions, and role-oriented definitions. Based on the critique of definitions, a revised definition for the specialty is proposed. This definition represents an evolutionary approach to defining nursing informatics, a logical step as the specialty matures.

Acknowledgments

The authors thank Patricia Flatley Brennan, PhD, RN, FAAN; Virginia K. Saba, PhD, RN, FAAN; and Rita Snyder-Halpern, PhD, RN, C, CNAA for their reviews of a preliminary draft of this manuscript. They also thank Judy Graves, PhD, RN, FAAN, who helped guide their theoretic thinking.

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• Canadian Nurses Association. (2006a). E-nursing strategy for Canada. Retrieved from http://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/e-nursing-strategy-for-canada.pdf?la=en
• Canadian Nurses Association, & Canada Health Infoway. (2014). National survey of Canadian nurses: use of digital health technologies in practice. Retrieved from http://www.infoway-inforoute.ca/en/component/edocman/1913-national-survey-of-canadian-nurses-use-of-digital-health-technologies-in-practice/view-document ;
• Healthcare Information and Management Systems Society. (2015). 2015 HIMSS impact of the informatics nurse survey. Retrieved from http://www.himss.org/ni-impact-survey
• HIMSS Nursing Informatics Awareness Task Force. (2007). An emerging giant nursing informatics. Nursing management, 38(3), 38-42 5p. doi:10.1097/01.NUMA.0000262926.85304.a6
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