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NIF 2ND SEM Prelim Reviewer
Theoretical foundation of nursing (TFN1)
Riverside College
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Module 1> Computer & Nursing L1- Concepts, Principles & Theories What is Nursing Informatics?
- a title that evolved from French word “Informatique”
- a specialty that integrates Nursing Science, Computer Science and Information Science
- referred to the field of applied computer science
- concerned with the processing of information such as nursing information Related Terms
- Nursing
- Informatics
- Electronic Health Record
- Telehealth
- Computer Literacy
- Information System
- Internet Systems Theory
- is largely accredited to the Austrian biologist, Karl Ludwig von Bertalanffy.
- The theory looks at interacting parts within boundaries, and can be seen with the use of technology and the body systems of patients. *
- The underlying principles of Systems Theory should seem largely intuitive to healthcare professionals. ** Cognitive Theory
- One of the basic building blocks to help understand informatics. *
- can be related to input, output, and processing.** It helps understand the information processed by our brains.***
- It includes: Problem solving Decision Making User centered interface Development and use of terminologies
Change Theory
- Kurt Lewin, (1890 – 1947) a Gestalt social psychologist, has been acknowledged as the “father of change theories” *
- is applied in looking at the dynamic processes that are incorporated with nursing informatics. It involves an action of planning and fact gathering before proceeding on to the next phase of action.
- Lewin’s change theory is a ‘planned change’ guide that consists of three distinct and vital stages: Unfreezing Stage Moving to a New Level or Change Stage Refreezing** 3 States of Data
- Data at rest
- Data in use
- Data in motion* Databases
- organized collection of related data - the possibility of finding databases depends on the following factors
- data naming (indexing) and organizational schemes
- size and complexity of the database
- type of data within the database 4. database search methodology**
Database Management System (DBMS)
- examples of DBMS in everyday life
- computerized library system
- automated teller machines
- flight reservation system
- advantages of automated DBMS
- decreased data redundancy
- increased data consistency
- improved access to all data*
- functions
- store the data
- update the records
- provide easy retrieval of the data
- permit report generation Data to Information Common Database Operations a. Data Input Operations
- input new data
- update data
- change or modify data
b. Data Processing Processes
- the purpose is to extract information
- discover new meanings
- reorder data c. Data Output Operations
- online and written reports
- processed data as charts and graphs Data Warehouses
- a large collection of data imported from several different systems into one database*
- data marts are smaller collections of data**
- purposes a. spares users from the need to learn several different applications b. makes it possible to separate the
analytical and operational processing c. provides an architectural design for the data warehouse that supports decisional information needs d. the user can slice ad dice the data from different angles and at different levels of detail Data Warehouses
- Functions a. must be able to extract data from the various computer systems and import those data into the data warehouse b. must function as a database to store and process the data in the database c. must be able to deliver data in the warehouse back to the users in the form of information Data/Information to Knowledge Data Mining
- to find previously unknown patterns and trends that will assist in providing quality care, predicting best treatment choices and utilizing health resources in a cost-effective manner Data/Information to Knowledge Knowledge Discovery and Data Mining (KDD)
- the process of extracting information and knowledge from large scale databases
- 7-step process: task analysis, data collection, data cleaning, data transformation, data mining,
pattern interpretation and evaluation, and deployment
- 3-step process by Bagga and Singh: pre-processing, data mining and post- processing* Wisdom Knowledge Application
- decision support systems produce knowledge from information
- expert systems use the knowledge from information and transform it to produce wisdom
- a proposed theory of nursing knowledge/wisdom uses the formula NKW(IB)=P Wisdom Expert Support/ Systems
- represent the present and future vanguard of nursing informatics
- aim to help make the nurse more intelligent in providing quality care based on evidence
Schwirian’s Model - NI activity was depicted as an interface between the computer hardware and software, raw nursing related information, and the user within the context of their profession or organization. All of these elements led to a common goal or objective.* Nursing Informatics is the interaction between the discipline specific science / Nursing Science and Areas of Informatics.*
Core Components of Informatics: Cognitive Science Information Science Computer Science Werley and Grier Model
*Their model integrated community data, institutional data, interpersonal data, and patient data into a hierarchical framework.
It was suggested that these information sets were needed to assist nurses in making decisions at various levels of functioning** Nurse—Computer Interaction -model made by Stagger’s and Park*
Framework which has been used to help understand interactions between nurses, computers, and enabling elements that optimize the ability of nurses to process information via computerized systems. ** Benner Novice to expert Model
Every nurse must be able to continuously exhibit the capability to acquire skills and the demonstrate specific skills beginning with the very first student experience.
According BENNER, there are 5 levels of expertise: Novice Advanced Beginner Competent Proficient
Historical Perspectives of Nursing Informatics Computers in Nursing
nursing information systems (NIS), nursing applications and/or nursing informatics(NI) affect all aspects of health care delivery*
manage patient care information, monitor quality and evaluate outcomes
document and process real time plans of care, support nursing research-and advance the roller nursing in the healthcare industry. Seven Time Period Prior to 1960s*
nursing profession was undergoing major changes
computers were used for basic office administrative and financial accounting functions only
used punch cards to store data and card readers to read computer programs
computers were linked together and operated by paper tape and used teletypewriters to print output. Seven Time Period 1960s
uses of computers in health care settings began to be explored*
nursing practice standards and resources were reviewed and analyzed
computer technology was advanced, and the number of health care facilities increased.* Seven Time Period 1970s*
nurses began to value the computers to their profession
computer assisted in the design and development of nursing applications for HIS and other environments where nurses functioned**
conferences helped public and home health nurses***
the opportunity to improve education using computer technology began Seven Time Period 1980s*
field of NI became visible in the healthcare industry and nursing as well as many mainframe HIS emerged with nursing subsystems*
discharge planning systems used as referrals and microcomputer or personal computer emerged
in 1985,the ANA approved the formation of the Council on Computer Applications in Nursing (CCAN)** Seven Time Period 1990s
NI became an integral part of health care settings, nursing practice-and profession
policies and legislations were adopted and nursing profession became actively involved in promoting NI
ANA approved NI as a new nursing specialty*
laptops and notebooks
LAN and WAN
internet and w w w Seven Time Period 2000s
data capture and data sharing technological tools were developed
*wireless, point-of-care, regional database projects and increased IT solutions
use of bar coding and radio frequency identification
smaller mobile devices with wireless or internet access and voice over internet protocol (VoIP) Seven Time Period 2010
genomic health care, shifting research paradigms and social technologies*
complete digitalization in healthcare information**
“meaningful use” Legislation*** Seven Time Period 2010s There are three basic components of meaningful use:
- The use of a certified EHR in a meaningful manner.
- The electronic exchange of health information to improve quality of health care.
- The use of certified EHR technology to submit clinical quality and other measures. Seven Time Period 2010s The Meaningful Use Criteria are driven by Health Outcomes Policy Priorities and Care Goals. •Improve the quality, safety, efficiency of health care, and reduce health disparities. •Engage patients and families. •Improve care coordination. •Improve public health. •Ensure adequate privacy and security protections for PHI.
Its members consisted of health care providers, payers, pharmaceutical companies and other industry organizations Module I : Computer and Nursing Lesson 3: Information Technology System Applicable in Nursing Practice “The voice arises from nurses as they participate in the process of using clinical information system to analyze data and information; exploring and understanding the informational and cognitive foundations specific to nursing; developing nursing wisdom and then applying to affect patient care.”-Meadows “The greatest struggle in nursing informatics is in the representation of nursing in a language that a computer can use.” – Abbott Barcode- Assisted Medication Administration ( BCMA )
Verifies that the right drug is being administered to the right pt at the right dose by the right route at the right time.
2 Unique patient identifiers ( JCAHO ) Barcode- Assisted Medication Administration Advantages
Up to date drug references information
Customized comments or alerts
Monitoring for pharmacy & nurse’s response to predetermined rules or standard
Reconciliation for pending STAT orders
Capturing data for analysis & monitoring
Verifying blood transfusion & laboratory specimen collection identification
Increased accountability & capture of charges Barcode- Assisted Medication Administration Possible Drawbacks
Wrong dosage form
Omission
Extra dose
Wrong drug
Wrong dose
Unauthorized drug
Charting errors Automated Dispensing
Computerized point of use medication management system
Allow the nurse to obtain patient- specific medication from drawers or bins that open after a drug is chosen from a pick list Automated Dispensing Cabinets Reason Behind Its Wide Acceptance
Improved pharmacy productivity
Enhance nursing productivity
Improved charge capture
Automated inventory control
Improved security of controlled substance
Timelier drug availability
Enhanced patient quality & safety Automated Dispensing Cabinets Possible Drawbacks
Lack of pharmacy screening of medication order prior to administration
Choosing of the wrong medication from an alphabet pick list
Problems in placing storing & returning of high alerts medication’s
Problem s with look a like & same packaging drugs next to each other. Smart infusion Pump
Used to deliver parenteral medications through IV or epidural lines
Found in a variety of clinical settings
Programmed with patient & drug parameter
Causes of error in programming
Incorrect, inappropriate or miscalculation Computerized Physician Order Entry ( CPOE )
Used for direct entry of one or more types of medical orders by a prescriber into a system
Allows to access record & enter orders remotely
Includes passive & active feedbacks systems
Physiologic Monitoring Systems Basic Components
- Sensor
- Signal Conditioner
- File
- Computer Processor 5 or Controlling Component Hemodynamic* Monitors
- allow for calculation-of hemodynamic indices
- the expert collection and analysis of qualitative and quantitative data of cardiopulmonary functions
- include clinical observation, the use of electrical photometric, pressure transducing equipment, and other non-invasive devices, as well as the application of several intravascular catheters Uses of Hemodynamic Monitors
- measure hemodynamic parameters
- closely examine cardiovascular problems
- evaluate cardiac pumps and volume status
- recognize patterns* and extract features
- assess vascular system integrity
- evaluate the patient’s physiologic response to stimuli continuously assess respiratory gases
- continuously evaluate blood gases and electrolytes
- estimate cellular oxygenation
- continuously evaluate glucose levels
- automatically transmit selected data to a computerized patient database Non-invasive Hemodynamic Monitors
Oscillometric Techniques
Pulse Oximetry
Doppler Invasive Hemodynamic Monitors
Pulmonary Artery Catheter
Thermistor
Fiber-optic Technology Critical Care Information System (CCIS)
- designed to collect, store, organize, retrieve, and manipulate all data related to the care of a critically-ill patient
- primary purpose: organization of patient’s current and historical data for use by all care providers in patient care** CCIS Components
- Patient Management
- Vital Signs Monitoring
- Diagnostic Testing Results 4. Clinical Documentation
- Decision Support
- Medication Management
- Interdisciplinary Plans of Care
- Provider Order Entry
Community Health Applications
- Community Health Nursing
- a synthesis of nursing practice and public health practice applied to promote and preserve the health of populations
- focus: population as a whole Computer Applications in CHN
- population focused
- continuity of care needs
- billing of services Computer SystemDevelopment
- CHN agencies have used computers since the late 1960s when computers were introduced into the healthcare industry
- Registration Systems
- designed to identify patients eligible for CHN services in clinics and homes
- can be accessed from local/district units prior to providing services 4 information System
- focus on the management statistical and operational needs of the agency and professionals Some of the Typically Used Systems
- Statistical Reporting
- developed to collect and process statistical information for health departments
- Special Purpose System -developedtocollectstatisticaldata for administering a specific program, regardless of what type of agency offers the program
- Public Health Information Network
-enablesconsistentexchangeof response, health, and disease tracking data between public
health partners
Modern Systems
- Automated IV PUMPS
- control the dosages and drips given to patients. Software and medical tech allows nurses to change the drip amounts and medication doses so patients aren’t waiting for changes. There are IV pumps for nutrition that give needed meals at the right times.
- Portable Monitors -Equipment allows nursing professionals to check on patients, even if they’re on the move or busy helping someone else. Portable devices monitor vital signs like ECG, respiratory rates, and oxygen saturations while transmitting the information back to a central monitor.
- Smart Bed Technology
- can help nurses track movement, weight, and even vitals. Smart beds also play a major role in keeping patients safe and comfortable during a long hospital stay. With the number of falls and patient injuries inside hospitals, smart beds are very important for patient safety. Smart bed technology gives nurses a constant in-room monitor that provides them with regular updates and communications on a patient’s activities.
- Wearable Devices
- Automated IV PUMPS
- Devices that help track heart rates, exercise, sleep, respiration, and more are helping people take their health into their own hands. With increased accessibility to iPhones, nurses also benefit from apps and devices that help them care for patients.
- Electronic Health Record
- are replacing older paper filing methods. Electronic Health Records allow nursing experts to document care provided to patients and retrieve information that can help prioritize care.
- Centralized Command Centers
- improved patient experiences and better ways for RNs and doctors to manage supplies, clinical technology, and capacity. This is done through software applications such as dashboards that provide real-time updates.
- Telehealth Apps
- is a valuable, newer element in healthcare. Hospitals and clinics allow patients to virtually video chat with a doctor or nurse to describe their symptoms or show doctors things like rashes or bumps. This helps patients with a quick diagnosis without leaving the comfort of their own home
NIF 2ND SEM Prelim Reviewer
Course: Theoretical foundation of nursing (TFN1)
University: Riverside College
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