NURSING INFORMATICS REVIEWER
Health informatics - a term that describes the acquisition, storage, retrieval and use
of healthcare information to foster better collaboration among a patient's various healthcare
providers.
Dependability and Healthcare Quality and Safety
System Reliability – the system consistently behaves the same way.
Service Availability – required services are present and usable when they are needed.
Confidentiality – sensitive information is disclosed only to those who authorized to see it.
Data Integrity – data are not corrupted or destroyed.
Responsiveness – the system responds to user input within an expected and acceptable
time period.
Safety – the system does not cause harm.
Guidelines for Dependable Systems - All computer systems are vulnerable to both human-created
threats (such as malicious code attacks
and software bugs) and natural threats (such as hardware aging and earthquakes).
Architect for Dependability – an enterprise system architecture should be developed from the
bottom up so that no critical component is dependent on a component less trustworthy that itself.
Anticipate Failures – features that are transparent to software applications should be
implemented to detect faults, to fail over to redundant components when faults are detected, and
to recover from failures before they become catastrophic.
Anticipate Success – the systems planning process should anticipate business success and
the consequential need for larger networks, more systems, new applications and additional
integration
Hire Meticulous Managers – good system administrators should meticulously monitor and
manage system and network performance.
Don’t be Adventurous – an organization must use only proven methods, tools, technologies
and products that have been in production, under conditions, at a scale similar to the intended
environment.
Clinical Information System Revisited - Patient care has become increasingly complex with the
widespread use of advanced technologies
in routine care. Healthcare providers must keep track of a staggering amount of information -- and
their failure to do so can have a detrimental effect on patient care.
Design, Implementation and Upgrading Clinical Information Systems
There are eight (8) phases of designing, implementing or upgrading a nursing information system:
The Planning Phase - The planning phase of the project begins once an organization has determined
that an existing need or problem may be filled or solved by the development or implementation of a CIS
or application.
Definition of the Problem – the project definition includes a description of the how the
system will be evaluated
Feasibility Study – is a preliminary analysis to determine if the proposed problem can be
solved by the implementation of a CIS or component application.
Documentation and Negotiation of Project Scope Agreement – A project scope
agreement is drafted by the project team and submitted to the project’s steering committee
for acceptance.
Allocation of Resources – A firm commitment of resources for development of the entire
CIS project scope agreement is needed before the system can fulfill its stated objectives.
The System Analysis Phase - The system analysis phase is considered the fact-finding phase. All data
requirements related to the problem defined in the project scope agreement are collected and
analyzed to gain a sound understanding of the current system, how it is used, and what is needed for
the current system.
Data Collection – the collection of data reflecting the existing problem or goal is the first step in
the system analysis phase.
Workflow document – assimilates the data collected into logical sequencing of tasks and
subtasks perform by the end users for each goal or problem area.
Functional design – is the overview of the statement of how the new system will work.
Data Analysis – the analysis provides the data for development of an overview of the nursing
problem and/or stated goal defined in the project scope agreement.
Data Review – the review focuses on resolving the problems and/or attaining the goals defined
in the feasibility study based on the methods or pathways derived from the workflow documents
and the functional design.
Benefits Identification – should reflect the resolution of the identified problem, formulated and
stated in quantifiable terms.
System Proposal Development – it includes submission to the project’s steering committee for
review and approval.
The System Design Phase - In the system design phase, the design details of the system and the detailed
plans for implementing the system are developed for both the functional and the technical
components of the system.
Functional Specifications – use the functional design document developed in the system
analysis phase of a CIS and builds on the design by formulating a detailed description of all
system inputs, outputs and processing logic required to complete the scope of the project.
Technical Specifications – dedicated technical manager is required. Each area requires that a
detailed technical specification be developed.
Implementation Planning – includes establishment of a detailed work plan. The work plan
identifies a responsible party and a beginning date and end date of each phase, step, task and
subtask.
The Development Phase - If the project steering committee decides to develop its own system
programs, the project staff must
proceed with the development phase which includes hardware selection, software development, test
system and document system.
The Testing Phase - The system, whether newly developed or commercially available, must be tested to
ensure all data are processed correctly and the desired outputs are generated.
The Training Phase - It is essential to train the end users on how to use the system properly. A CIS will
function only as well as its users understand its operation and the operation streamline the work.
The Implementation Phase - The implementation phase organizes all steps into a detailed plan
describing the series of events required to begin using the system or application in the production or live
environment and details the necessary computer and software maintenance operations required to
keep the system running.
The Evaluation Phase - The evaluation phase describes and assesses, in detail, the new system’s
performance.
Clinical Information System (CIS) - an information system designed specifically for use in the
critical care environment, such as in an Intensive Care Unit (ICU).
Technologies in Critical Care - Critical care nursing is that specialty within nursing that deals specifically
with human responses to life-threatening problems.
Acute Care Physiologic Monitoring System – comprehensive patient monitoring systems
that can be configured to measure and display various patient parameters.
Pulse Oximeter – measure the arterial hemoglobin oxygen saturation of the patient's blood
with a sensor clipped over the finger or toe.
Intracranial Pressure Monitors - are connected to sensors inserted into the brain through a
cannula or bur hole. These devices warn of elevated pressure and record or display pressure trends.
Apnea Monitors - use electrodes or sensors placed on the patient to detect cessation of
breathing, display respiration parameters, and trigger an alarm if a certain amount of time
passes without a patient's breath being detected.
Ventilators - consist of a flexible breathing circuit, gas supply, heating/humidification
mechanism, monitors, and alarms.
Infusion Pumps - employ automatic, programmable pumping mechanisms to supply the
patient with fluids intravenously or epidurally through a catheter.
Crash Carts - also called resuscitation carts or code carts, are strategically located in the
ICU for immediate availability when a patient experiences cardio-respiratory failure.
Intra-Aortic Balloon Pump - use a balloon placed in the patient's aorta to help the heart
pump. The balloon is on the end of a catheter that is connected to the pump's console, which
displays heart rate, pressure, and ECG readings.
Clinical Focus: Physiologic Monitoring Systems - Patient monitoring is pivotal for the appropriate
assessment, diagnosis and treatment of patients.
The Community Health Network System - A community health network is an innovative ambulatory
care system specially developed to provide services by the computer.
Home high-tech monitoring systems - are using computers to link patients at home to healthcare
facilities.
Care Watch – home tele-monitoring program for patients with congestive heart failure
Remote Defibrillator – allows hospitals to diagnose and resuscitate a homebound patient
who has suffered a cardiac arrest.
Sophisticated Telemetry Devices – examples are digitized x-rays and ECG, electronic
stethoscopes, and interactive video equipment that uses telecommunication technology
Alert Systems – communication devices that allow the homebound to signal for help in case
of emergency
Informatics in Ambulatory Care - It is characterized by rapid, focused
assessments of patients, long-term nurse/patient/family relationships, and teaching and translating
prescriptions for care into doable activities for patients and their caregivers
Physiologic monitoring systems - a system that monitors vital physiologic parameters so that
clinicians can be informed of changes in a patient's condition.
Nurses and the Internet - Contemporary nursing practice has changed tremendously over the last
decade. Professional competencies for new nurses now include informatics, case management, health
care policy, cultural sensitivity, and disaster preparedness.
NLM Gateway - This site is a handy entry point for searching the many valuable resources at
the National Library of Medicine.
Agency for Healthcare Research and Quality (AHRQ) - this federal agency both conducts
and sponsors research on healthcare quality, safety, and cost-effectiveness.
National Institute of Nursing Research - one of the National Institutes of Health, this
organization’s mission is to support research in nursing in clinical and community settings
through grants and other funding programs.
Pubmed Central - a free “digital archive of life sciences journal literature,” the site offers
access to the full text of more than 160 high-quality, open access life sciences journals from
various publishers.
Centers for Disease Control (CDC) and Prevention - the CDC’s mission is to monitor public
health, put forth prevention initiatives, investigate health problems, and promote healthy
behaviors.
Healthfinder - this consumer health information site is maintained by the National Health
Information Center of the U.S. Department of Health and Human Services.
MedlinePlus - a consumer health resource that brings together information from various
government agencies, including the National Library of Medicine, the National Institutes for
Health, and others, MedlinePlus provides simple but accurate health-related information for the
general public.
National Institutes of Health—Health Information - another directory of consumer health
information, this site has a simple design, and is organized by conditions, body systems, type of
patient, etc.
BioMed Central - this resource publishes more than 140 open access journals covering all
areas of biology and medicine.
HealthWeb - this well-organized collection of evaluated, noncommercial resources is a
collaborative project of health sciences libraries at more than 20 leading academic medical
centers in the Midwest.
Mayo Clinic: Tools for Healthier Lives - though aimed at the layperson, nurses and students
will welcome the plethora of information and tools provided by Mayo Clinic.
Onlilne Journal of Issues in Nursing (OJIN) - OJIN is a free, peer-reviewed, international
journal addressing topics affecting nursing practice, research, education, and the wider health
care sector.
Public Library of Science (PLoS) - PLoS is an initiative by scientists and doctors to publish
quality, peer-reviewed literature and make it freely available to the public and other
researchers.
World Health Organization (WHO) - an excellent source of global health information, including
statistics and country-by-country health overviews.
Alzheimer's Association - the Alzheimer's Association provides information and support to
family members, caregivers, and health professionals on Alzheimer's disease.
HIV InSite: Gateway to AIDS Knowledge - San Francisco School of Medicine
gives comprehensive, up-to-date information on HIV/AIDS treatment, prevention, and policy at
this site.
Oncolink - University of Pennsylvania cancer specialists launched this site in 1994 to "help
cancer patients, families, health care professionals and the general public get accurate cancer-
related information at no charge.
Public Health Nursing Section of the American Public Health Association - this site
provides current health-related news, links to information about public health advocacy, articles
American Nurses Association (ANA) - the ANA represents American registered nurses
(RNs).
International Council of Nurses - "A federation of National Nurses ‘Associations (NNAs),
representing nurses in more than 128 countries," that focuses on quality in nursing
internationally and global health policy.
Links to nursing organizations at the National Institute of Nursing Research - the National Institute for
Nursing Research, described earlier, offers an excellent list of links to scores of
organizations representing nursing specialties and issues in nursing.
National Council of State Boards of Nursing - this nonprofit membership organization is
comprised of State Boards of Nursing from the United States and its territories.
National League for Nursing (NLN) - NLN is a membership organization whose mission is to
advance "excellence in nursing education" and prepare the workforce to "meet the needs of a
diverse population in an ever-changing healthcare environment."
National Coalition of Ethnic and Minority Nurse Associations (NCEMNA) - NCEMNA offers
information and links to American nurses’ associations representing major U.S. ethnic groups,
including Asian American/Pacific Islander
National Federation of Licensed Practical Nurses (NFLPN) -NFLPN, the organization for
LPNs, vocational nurses and nursing students, fosters competence through continuing education and
professionalism.
Philippine Nurses Association – the official webpage for the PNA. Access: http://www.pna-
ph.org/
Nurse Directory - contains information regarding nursing industry including Nurse Companies,
Nursing Review Centers, Nursing Schools, Care Givers, and Nursing articles.
Internet - a global wide area network that connects computer systems across the world.
Internet service provider (ISP) - an organization that provides services for accessing, using, or
participating in the Internet
The Nursing Curriculum in the Information Age - Nursing is an information-intensive profession, and
nursing education relies heavily on the acquisition of information to educate students in their
professional programs.
Nursing Education Informatics Model - A number of models have been presented for educators to
emulate in designing curriculum for the inclusion of nursing informatics.
AMA Medical Ethics Web Pages - the American Medical Association (AMA) offers resources
and information about medical ethics.
Geriatric Assessment-Case Studies - the Virtual Health Care Team Web site is sponsored by
the School of Health Professions and the School of Medicine at University of Missouri.
Gray’s Anatomy of the Human Body - the Bartleby.com edition of Gray’s Anatomy features
1,247 pictures from the classic 1918 publication, as well as a subject index with 13,000 entries.
Human Anatomy Online - easy to navigate, the user begins by choosing among ten systems:
skeletal, digestive, muscular, lymphatic, endocrine, nervous, cardiovascular, male or female
reproductive, and urinary.
McGill University Virtual Stethoscope - this is surely a unique Internet resource for medical
and nursing students. As its name suggests, it is a multimedia tutorial featuring a virtual
stethoscope (Real Player needed) to assess both respiratory and cardiovascular conditions.
Merck Manual of Diagnosis and Therapy - The Merck Manual’s 17th, Centennial Edition is
available free, searchable by keyword or the table of contents.
Physical Exam Study Guides - created by the University of Florida Medical program, these
guides are thorough and clear.
RN Central - created by nurses for nurses and students, this site offers good resource links,
but the highlight is its “Careplan Corner,”
RxList - information provided for each drug includes the description, clinical pharmacology,
indications and dosage, side effects and drug interactions, warnings and precautions, drug over
dosage, contraindications, and patient information.
Computers in Nursing Research - The use of computers and software applications are ubiquitous
throughout the research.
United States of America - The earliest use of computation for health was for dental projects in the
1950s at the United States National Bureau of Standards by Robert Ledley.
Europe - The uropean Union's Member States are committed to sharing their best practices and
experiences to create a European eHealth Area, thereby improving access to and quality
healthcare at the same time as stimulating growth in a promising new industrial sector.
Asia – In Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for
Medical Informatics (APAMI) was established in 1994 and now consists of more than 15 member
regions in the Asia Pacific Region
Australia - In 2002 the Australian College of Health Informatics (ACHI) was formed as a professional
association and peak health informatics professional body.
New Zealand - Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose
focus is to facilitate improvements in business processes and patient care in the health sector through
the application of appropriate information technologies.
Nursing Informatics in the Future - In every aspect of patient care nurse constantly, assess, diagnose,
determine the appropriate action and evaluate and communicate it.
Nursing informatics (NI) - is the specialty that integrates nursing science with multiple information
management and analytical sciences to identify, define, manage, and communicate data,
information, knowledge, and wisdom in nursing practice.
