INTRODUCTION
Nursing “informatics is a distinct specialty within nursing. With a history dating back 25 years,
nursing informatics is defined 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. Nursing informatics supports nurses,
consumers, patients, the inter-professional healthcare team, and other stakeholders in their
decision making in all roles and settings to achieve desired outcomes.
Information Science
Information “science is the science and practice dealing with the effective collection, storage,
retrieval, and use of information. It is concerned with recordable information and knowledge,
and the technologies and related services that facilitate their management and use. Information
Science is a multidisciplinary science that involves aspect from computer science, cognitive
science, social science, communication science, and library science to deal with obtaining,
gathering, organising, manipulating, managing, storing, retrieving, recapturing, disposing of,
distributing, or broadcasting information. Information Science studies everything that deals
with information and can be defined as the study of information systems. This science
originated as a sub-discipline of computer science, in an attempt to understand and rationalise
the management of technology within organisations. It has matured into a major field of
management that is increasingly being emphasised as an important area of research in
management studies and has expanded to examine the human-computer interaction,
interfacing, and interaction of people, information systems, and corporation. It is taught at all
major universities and business schools around the world. Organisations have become intensely
aware of the fact that information and knowledge are potent resources that must be cultivated
and honed to meet their” needs.
In the mid-1980’s Blum (1986) introduced the concepts of data, information and knowledge as
a framework for understanding clinical information systems and their impact on health care.
He did this by classifying the then-current clinical information systems by the three types of
objects that these systems processed. These were data, information and” knowledge.
Nursing Informatics
The term “nursing informatics” was “initially seen in literature in the 1980s, including a
definition of combining nursing, information, and computer sciences for managing and
processing data into knowledge for using in nursing practice (Murphy, 2010). In 1994, The
American Nurses Association (ANA) began developing a statement to describe and define the
scope of nursing informatics (Baker, 2012). The meaning of nursing informatics has evolved
and been refined, with the American Nurses Association (2008) definition stated as “a specialty
that integrates nursing science, computer science, and information science to manage and
communicate data, information, knowledge, and wisdom in nursing practice” (p. 65). Another
definition of nursing informatics comes from the American Medical Informatics Association
(AMIA), which” states “Nursing Informatics science and practice integrates nursing, its
information and knowledge and their management, with information and communication
technologies to promote the health of people, families and communities worldwide” (2009,
para. 1).
Nursing Informatics (NI) has also been defined “as a specialty that integrates nursing science,
computer science, and information science to manage and communicate data, information,
knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses, and other
providers in their decision making in all roles and settings. This support is accomplished using
information structures, information processes, and information” technology
Staggers and Thompson (2002) believed that there were too many definitions for NI, which
was causing the specialty to grow without a solid foundation. They believed that without this
foundation it was difficult to build a solid informatics practice or the needed educational base
for this specialty practice. Staggers and Thompson performed a critical analysis of the
definitions, which resulted in a new definition. The new definition is as follows:
The “goal of NI is to improve the health of populations, communities, families, and individuals
by optimizing information management and communication. These activities include the
design and use of informatics solutions and/or technology to support all areas of nursing,
including, but not limited to, the direct provision of care, establishing effective administrative
systems, designing useful decision support systems, managing and delivering educational
experiences, enhancing supporting life-long learning, and supporting nursing research. The
term individuals refer to patients, healthcare consumers and any other recipient of nursing care
or informatics solutions. The term patient refers to consumers in both a wellness and illness”
model.
History of Nursing Informatics
In order “to understand NI, one must understand its history, health care began to use computers
in the 1950s. Computers in this era were typically used in the business office (Saba &
McCormick, 2006). In the 1970s, nursing began to realise the importance of computers to the
nursing profession and became involved in the design, purchase, and purchase of information
systems (Saba & McCormick). In the 1980s, medical and nursing informatics specialties emerged. The
personal computer was introduced, which allowed for flexibility in how these
clinical systems were used. It also brought to everyone’s attention that not just NI specialist,
but all healthcare personnel, would need to know about these systems. The first certification
for NI was taken in 1995. The post-2000 era saw an unprecedented explosion in the number
and sophistication of both computer hardware and software. Electronic patient recorded
became an integral part of clinical information systems. Telemedicine became possible and
was recognised as a specialty in the late 1990s. NI has experienced rapid growth in the last b40
years, and it does not appear to be slowing. It will be interesting to see what will happen over
the next 40 years.
Nursing informatics as a field emerged from the overarching discipline of health informatics
and alongside the expanding field of medical informatics. At present, it is a field of study which
is still developing and is based on the concept that health care data and information can be
effectively managed and communicated using computer systems, networks, modems and
telecommunications.
Informatics is modelled after the French word informatique and was first used as medical
informatics in the late 1970s, followed by use in nursing in the 1980s. The ANA designated
nursing informatics as a specialty practice in 1992, although nurses had earlier incorporated
informatics concepts. Subsequently, volunteer ANA members have developed a scope and
standards for practice, which serves as guides for the practice, which serve as guides for” the
Practice
Evolution of Nursing Informatics
A review “of definitions of nursing informatics by Staggers and Bagley-Thompson (2002)
categorised the definition into three themes: Information technology-oriented, conceptually
oriented and role oriented definitions. An early definition by Scholes and Barber (1980) 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 (1985) modified an
early definition of medical informatics, acknowledging that all health care professionals are
part of medical 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.
The emphasis “on technology is not limited to early definitions. More recently, Hannah et
al. and Saba and McCormick 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.
The “information technology-oriented view of nursing informatics may be critiqued for
overstating the role of technology and underemphasising the need for the informatics nurse
specialist to support the cognitive interaction between the nurse, the nursing process, nursing data,
patients and the technology. This do not easily suggest the informatics functions a nurse
might assume in a health care organisation 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.
Conceptually Oriented Definitions
A shift “from technology-focused definitions to more conceptually oriented definitions began
during the mid-1980s. Schwirian 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 emphasised the need for informatics research to be “proactive and
model-driven rather than reactive and problem-driven. “Her research model outlined a pyramid
of users, nursing-related information, goals, and computers (hardware and software)
interconnected with” bidirectional arrows.
Graves and Corcoran 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.
This definition “broadened the horizon from technology and placed nursing informatics firmly
within the practice of nursing. It also provided the first acknowledgement in nursing of an
information-knowledge link, using concepts borrowed from Blois, 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 of 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. 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 definition4
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.
Nursing is increasingly becoming as “high tech” as it is a “high touch” profession. Today’s
nurses have “more technology at their disposal than any nurses ever before, and as one might
expect, it’s considerably improving” patient care.
One area where “nurses are putting technology to use is in informatics. Officially known as the
study of information, in the world of health care, health informatics is the management of health
information. Using electronic medical records, devices that collect health information
electronically, and other electronic information standards, health informatics nurses are
responsible for managing, interpreting, and communicating the data that comes in and out of
health care facilities, all with one primary purpose: Improving the quality” of patient care.
Nursing Information “System (NIS) is a part of a health care information system that deals with
nursing aspects, particularly the maintenance of the nursing record. The several objectives that
a Nursing Information system should meet in order to succeed its aims, cover the users' needs
and operate properly are described. The functions of such systems, which combine with the
basic tasks of the nursing care process, are examined. As Nursing Information System is part
of the health care and hospital information system, the different strategies and approaches for
designing and developing Hospital Information Systems followed from the decade of 1970
until the recent decade of 1990, are presented.
Motivation for the development and implementation of computerized hospital information
systems has been financial and administrative, i.e. driven by the need to capture charges and
document patient care for legal reasons. The majority of systems marketed today have been
motivated by those two factors. Historically, such systems have required a major investment in
hardware (typically mainframe, desktop and laptops), and, even though they have demonstrated
significant improvement in hospital communication (with a corresponding reduction in paper
flow), they” have been characteristically “weak in supporting the professional nursing practice.
These factors have prevented the level of acceptance by nurses that was originally foreseen.
If one considers the original principle that CampBell (1978) identified when looking at the
activities nurses perform when caring for patients, nursing roles falls into three global
categories.
The first is managerial roles or coordinating activities, for example, order entry, result
reporting, requisition generation and telephone booking of appointments. Current hospital
information systems can help nurses with those activities.
The second is the Physician-delegated task. Current systems can capture these from the
physicians’ order entry set and then incorporate them into the patient care plan.
The third category is the autonomous nursing function, characteristics of nursing professional
nursing activities, when knowledge unite to nursing is applied to patient care. Current system
are beginning to support nurses in fulfilling their responsibilities in this categories.
All three categories – managerial/coordinating, physician-delegated, and autonomous nursing
function – must fit together to create a fully operational system. Present system, while they
release nurse to focus on professional nursing practice. The future will require decision-making
support for professional nursing practice and the capture of information from the patient care
plan for nursing administration decision making related to nursing resources” allocation
