Theories Models and Frameworks Nursing Informatics Is an

Theories, Models and Frameworks

Nursing Informatics Ø Is an established and growing area of specialization in nursing. Ø Informatics nurses are key persons in designs, development, implementation, and evaluation of these technologies and in the development of the specialty’s body of knowledge.

Informatics and Healthcare Informatics Ø Informatics is a science that combines a domain science, computer science, information science, and cognitive. Ø Healthcare informatics may be defined as the integration of healthcare sciences, computer, information, and cognitive science to assist in the management of healthcare information.

Nursing Informatics Models Ø Ø Ø Graves and Corcoran’s model Schiwirian’s model Turley’s model Data Information Knowledge (D-I-K) model Benner’s Novice to Expert model

Graves and Corcoran’s Model (1989) q Nursing Informatics as a linear progression – from data into information and knowledge. q Management processing is integrated within each elements, depicting nursing informatics as the proper management of knowledge – from data as it is converted into information and knowledge.

Management Data Information Knowledge

Schiwirian’s Model (1989) q Nursing informatics involves identification of information needs, resolution of the needs, and attainment of nursing goals/objectives. Patricia Schiwirian- proposed a model intended to stimulate and guide systematic in nursing informatics. q Model/framework that enables identification of significant information needs that can foster research (somewhat similar to Maslow’s hierarchy of needs) q

GOAL USERS TECHNOLOGY RAW MATERIALS (Nursing related informatics)

TURLEY’S MODEL (1996) Nursing informatics is the interaction between the discipline-specific science (nursing) and the areas of informatics q Core components of informatics: § Cognitive science § Information science § Computer science •

COMPUTER SCIENCE NURSING INFORMATION SCIENCE COGNITIVE SCIENCE

DATA-INFORMATIONKNOWLEDGE MODEL NI is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom into nursing practice (ANA). q NI is an evolving, dynamic process involving the conversion of data into information, subsequently knowledge. q Important Note: Processing of information does not always result in the development of knowledge. q

C O M P L E X I T Y KNOWLEDGE INFORMATION DATA HUMAN INTELLECT

BENNER’S LEVEL OF EXPERTISE MODEL q Every nurses must be able to continuously exhibit the capability to acquire skill ( in this case, computer literacy skills parallel with nursing knowledge) and then demonstrate specific skills beginning with the very first student experience.

Levels of Expertise (Benner): Novice- individuals with no experience of situations and related content in those situations where they are expected to perform tasks. § Advance Beginner- marginally demonstrate acceptable performance having built on lessons learned in their expanding experience base; needs supervision. § Competence- enhanced mastery and the ability to cope with and manage contingencies. §

Proficient- evolution through continuous practice of skills, combined with professional experience and knowledge; individual who appreciates standards of practice as they apply in nursing informatics. § Expert- individual with mastery of the concept and capacity to intuitively understand the situation and immediately target the problem with minimal effort or problem solving. §

EXPERT PROFICIENT COMPETENT ADVANCE BEGINNER NOVICE

PATIENT MEDICAL RECORD INFORMATION (PMRI): BASIS OF EHR The type and pattern of documentation in the patient record will be dependent on 3 interacting dimensions of health care: • Personal health dimensions- PHR maintained and controlled by the individual or family; nonclinical information. E. g. . Self-care trackers, directories of health care, and other supports • Health care provider dimension- promotes quality patient care, access to complete accurate patient data 24/7. E. g. . provider’s notes/prescription, clinical orders decision support system, practice guidelines •

§ Population health dimension- information on the health of the population and the influences to health; helps stakeholders identify and track health threats, assess population health, create and monitor programs and services and conduct research e. g. Ushahidi program

Important Terminologies (Data Sets): § § § § ABC codes Perioperative Nursing Data Set (PNDS) SNOMED CT International Classification for Nursing Practice (ICNP) Patient Care Data Set (PCDS) NANDA LOINC

ABC CODES q Mechanism for coding integrative health interventions by clinician for administrative billing and insurance claims q Includes complementary alternative medicine intervention and codes that map all NIC, CCC, and Omaha system interventions

Perioperative Nursing Data Set (PNDS) q Universal language for perioperative nursing practice and education; standardize documentation of perioperative data in all perioperative settings. q Diagnosis based on NANDA intervention based on NIC, and outcomes based on NOC

SNOMED CT q Core clinical terminology containing over 357, 000 healthcare concepts with unique meaning and formal logic-based definitions organized into multiple hierarchies.

International Classification for Nursing Practice (ICNP) q Integrated terminology for nursing practice developed under sponsorship of ICNP elements: Nursing phenomena (nursing diagnosis) § Nursing actions (nursing interventions) § Nursing outcomes §

Patient Care Data Set (PCDS) q Terms and codes for patient problems, therapeutic goals, and care orders. q Developed by Dr. Judith Osbolt

NANDA Has evolved from an alphabetical listing in the mid- 1980’s to a conceptual system that guides the classification of nursing diagnoses in a taxonomy and includes definitions and defining characteristics. q Currently includes 167 recognized diagnoses focus of the terms used for medicine and third party payment claims. q

Logical Observation Identifiers Names and Codes (LOINC) Originated as database of standardized laboratory terms for results reporting for chemistry, hematology, microbiology, serology and toxicology. q Including a clinical portion with codes for observations at key stages of the nursing process, including assessments, goals, and outcomes. Such entries V/S, I&O. ECG and etc. q

ORGANIZATION as resources AMIA § NLN § HIMSS §

American Medical Informatics Association (AMIA) • Authoritative body in the field of medical informatics and frequently represents the US in the informational area of medical forums. • Dedicated to the development and application of medical informatics in the support of patient care, teaching, research and healthcare administration

National League for Nursing (NLN) � Mission: to advance quality nursing education that prepares the nursing workforce to meet the needs of diverse population in an ever-changing healthcare environment. � Addresses faculty development and educational research

Healthcare Information and Management Systems Society (HIMSS) � Assumes leadership role in the health care information technology standards of nursing and advocacy of key innovations in health care delivery and administration.