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ENHANCING CLINICALCARE THROUGH NURSING
INFORMATICS
DECEMBER 14, 2009
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QUOTE OF THE DAY
"Computers are incredibly fast,accurate and stupid. Human
beings are incredibly slow,inaccurate and brilliant.
Together they are powerfulbeyond imagination."
- Albert Einstein
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DO YOU KNOW WHAT A TOILET
BOWL CAN DO?
can redden faces
can measure sugar levels in urine
can measure blood pressure,heartbeat, body fat and weight
can do nearly everything
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An American diplomat was at adinner party in a Japanese home
when he excused himself to go tothe bathroom. He did his
business, stood up and realizedhe didn't have a clue about how toflush the toilet.
REDDEN FACE?
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The diplomat speaks Japanese, buthe was still baffled by the colorful
array of buttons on the complicatedkeypad on the toilet. So he just
started pushing. He hit the
noisemaker button that makes aflushing sound to mask any noise
you might be making.
REDDEN FACE?
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He hit the button that starts theblowdryer for your bottom. Then he
hit the bidet button and watchedhelplessly as a little plastic arm, sort
of a squirt gun shaped like a
toothbrush, appeared from the backof the bowl and began shooting astream of warm water across the
room and onto the mirror.
REDDEN FACE?
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And that's how one ofAmerica'spromising young Foreign Service
officers ended up frantically wipingdown a Japanese bathroom with a
wad of toilet paper.
"It was one of my most embarrassingexperiences in Japan," said theembassy employee who asked not to
be identified.
REDDEN FACE?
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NEOREST 600
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The Neorest 600 from Japanese plumbingmanufacturer Toto is a tankless toilet andpersonal cleansing unit. Its lid automatically
opens when a person approaches it. Whena person walks away from the Neorest 600,it automatically flushes and closes the seatand lid. There's a remote control for
operating features including water spraytemperature, pressure and direction; seatheater; air dryer; and deodorizer. List prices
for the Neorest 600 start at US$5,200.
NEOREST 600
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FRIENDLY RESTROOM
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Built-in assistance: The Friendly Rest Roomcombines a slew of high-tech features including acontactless smart card to store users' preferences,voice activation interface, and sensor systems for
detecting falls and emergency situations. Users cancontrol settings including seat height and tilt with aremote control or voice-activated commands.Researchers affiliated with Vienna University of
Technology in Austria conceived the Friendly RestRoom as a way to provide greater independence toelderly and disabled people who might otherwiserely on assistance from a caregiver to use a toilet.
FRIENDLY RESTROOM
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INTELLIGENT TOILET
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Japanese homebuilder DaiwaHouse Industry collaborated
with Toto to design theIntelligent Toilet, which doublesas an in-home health monitor.
The design includes devices formeasuring sugar levels in urine,blood pressure, body fat and
weight.
INTELLIGENT TOILET
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WHO AMONG US ARE LIKE
THIS FELLOW?
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HOW?
BY IMPROVING
YOUR
COMPUTERLITERACY
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COMPUTER LITERACY
On the least specialized level,computer literacy involves knowinghow to turn on a computer, start andstop simple application programs, andsave and print information. It alsorefers to the attitude about computersand the actual ability to do sometasks or programs on the computer.
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COMPUTER LITERACY
The relationship between computerliteracy, technological competenceand a nurse's ability to care iscongruent for quality care. Computerliteracy represents a proactiveresponse to technology whichenhances caring in nursing (Delaney,1990).
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COMPUTER LITERACY
AM ICOMPUTERLITERATE?
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ANIA
BCMA CI
CPOE CPU
CPRS
EHR
EMR HIS
PC PDA
RAM
HOW FAR DO YOU KNOW?
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TOP BUSINESS ISSUES IMPACTINGHEALTHCARE
1. Increasing PatientSafety/Reducing Medical
Errors
2. Patient (Customer) Satisfaction
3. Nursing Shortage
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1. Reduce MedicalErrors/Promote Patient Safety
2. Implement an EMR
3. Connecting IT at Hospital and
Remote Locations
Source: Healthcare Information and Management Systems Society (HIMSS)
CURRENT IT PRIORITIES
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Fragmented, frequently interrupted, in chaoticwork environment
Interrupted mid-activity 8 times per every 8 hours*
Switch patients every 11 minutes* Average activity time 3.1 min/care activity*
Average of 8.1 operational failures per 8hours*
Missing med
Missing supplies
Missing order
Missing/ broken equipment
CHALLENGES FOR NURSING
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9% of time spent on resolving systemfailures or errors*
Most common was missing medications
Direct patient care tasks done in 2:43
minutes chunks Average 44 minutes overtime
Only 30% of shift time is in direct patient
care** Medication administration errors
in 1999, ADE cost the U.S. $2 billion annually
Sources:* Tucker and Spear.Operational Failures and Interruptions in Hospital Nursing. HSR 41:643-662, 2006
** Hendrich A., George V. Random work sampling ofMedical Surgical nurses using PDAs. Reported atHealth Management Academy, May 20, 2004. Unpublished Data
CHALLENGES FOR NURSING
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We practice with incomplete information
We have alarming error rates
We spend 30-50% of time on administrative
activities Errors are associated with surveillance,
change in venues, and patient handoffs
Fragmented, incomplete records can causeconfusion, communication breakdown, andthe opportunity for error.
We need to reduce burdens related to
documentation
CHALLENGES FOR CLINICIANS
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LEARNING OBJECTIVES
Define nursing informatics Demonstrate how NI supports nursing
process
Explain the value of NI to nursing practiceand healthcare
Identify roles for NI practice
Identify practice areas and settings Identify education paths and certifications
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The healthcare of your clients is largelydependant on information.
Every action taken depends on previous
information and knowledge. The delivery of health care requiresinformation about: Science of type of care (nursing)
Patient or client Provider
Outcomes
Process and systems for delivery of care
THE IMPORTANCE OF INFORMATIONTHE IMPORTANCE OF INFORMATION
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Information about each of these areashave an impact on the type and theamount of care given.
Information must be:accurate
timely
accessibleunderstandable
THE IMPORTANCE OF INFORMATIONTHE IMPORTANCE OF INFORMATION
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The structure of information Delivered in conversation, handwritten notes,
stored in a computer.
Regardless of the form, the same basicprinciples apply to the structure and the useofinformation.
Words are often used interchangeably todescribe information.
WHAT IS INFORMATION?WHAT IS INFORMATION?
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The structure of information
Data: discrete entities objectively described,without interpretation or context.
Example: 110
Information: data processed into a structured form.Data that are interpreted, organized, structuredand given meaning are referred to as information.
Example: When combining 110 with other data, itbecomes information. Systolic blood pressure of 110mmHg and diastolic blood pressure of70 mm Hg. Thisinformation can be captured in a form, on a graph in areport.
WHAT IS INFORMATION?WHAT IS INFORMATION?
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Knowledge: synthesized informationderived from the interpretation of data. Itprovides a logical basis for making
decisions.Essential to decision-making andto new discoveries.
Example: When the blood pressurereading is combined with informationabout anatomy and physiology,pharmacology, pathophysiology,knowledge is used to decide about
further care and treatment.
WHAT IS INFORMATION?WHAT IS INFORMATION?
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Information has five rights:
Right information
Right personRight time
Right place
Right amount
THE FIVE RIGHTS OF INFORMATIONTHE FIVE RIGHTS OF INFORMATION
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USING INFORMATION
Up-to-date,accurateinformation of
each step of theNursingProcess is thePowerbehind
safe, highquality patient-centered care!
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Evidence-based practice leads to: Determining standards and guidelines
Guide for decision-making process
Determines best practice
Nursing informatics can enable dissemination ofnew knowledge. Practitioners update themselves of new
developments through journals, conferences,
continuing education sessions. The information is varied and copious.
There is a need to find the relevant evidence in atimely way.
USING INFORMATIONUSING INFORMATION
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With the knowledge of the importance ofinformation in healthcare, healthcareinformatics has become a specialty.
Healthcare informatics is a combination ofcomputer science, healthcare science,information science and cognitive
science.
WHAT IS HEALTHCARE INFORMATICS?WHAT IS HEALTHCARE INFORMATICS?
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Computer science: development, configuration,architecture of computer hardware and software.
Healthcare science: body of knowledge on
which healthcare profession bases theirpractice. The sciences of anatomy, physiologyand knowledge specific to each profession.
Information science: also includes information
technology which involves the process ofsending and receiving information.
Cognitive science: the process of humanthinking, understanding and remembering.
WHAT IS HEALTHCARE INFORMATICS?WHAT IS HEALTHCARE INFORMATICS?
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1992 First Scope ofPractice forInformatics Nurse
1992 Informatics Nursing recognized asa specialty by ANA
1994 First Informatics NursingCertification exam offered by ANCC
2007 3rd Version of Informatics Nursing
Scope ofPractice 2007: AONE identifies InformationManagement and Technology as a core
competency for Nurse Executives
HOW FAR HAVE WE COME?
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WHAT IS NURSING INFORMATICS (NI)?
Nursing Informatics is a specialty thatintegrates nursing science, computer science,and information science to manage andcommunicate data, information, and
knowledge in nursing practice. Nursinginformatics facilitates the integration of data,information, knowledge, and wisdom tosupport patients, nurses and otherprovidersin their decision-making in all roles and
settings. This support is accomplishedthrough the use of information structures,information processes, and informationtechnology.
(ANA Scope & StandardsofNursingInformatics Practice, 2008)
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WHAT IS NURSING INFORMATICS (NI)?
Like any knowledge-intensive field thesedays, nursing is greatly impacted by theexplosive growth of computer technology.
Nursing informatics is a new and excitingspecialty that combines nursing skills withcomputer expertise. Nurse informaticsspecialists manage and communicate
nursing data and information to improvedecision making by consumers, patients,nurses and other health care providers.
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System Lifecycle
Human Factors
Information Technology Information Management
Professional Practice
Models and Theories
SCOPE & STANDARDS OF PRACTICE
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IN vs. INS
IN Informatics Nurse: RN who works in the area of informatics
This RN is not formally prepared in
informatics but has an interest and/orexperience working in the area.
INS Informatics Nurse Specialist:
RN with advanced, graduate education innursing informatics or informationmanagement
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NI SPECIALIST SALARY
In 2007, the Healthcare Information andManagement Systems Society (HIMSS)conducted a major survey of nurse
informatics specialists. The average salaryearned by respondents to this survey was$83,675, compared to $69,500 in the 2004survey. This is strong evidence of theincreasing maturity and value of thespecialty.
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NURSE INFORMATICS CAREER OUTLOOK
The demand for all types of nurses isexpected to increase significantly over thenext ten years. In general, the more
training, certifications and experience anurse has, the more demand there will befor his or her skill set.
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HEALTHCARE INFORMATION AND MANAGEMENTSYSTEMS SOCIETY (HIMSS) LEVEL 7
STAGE CUMMULATIVE CAPABILITIES % OFHOSPITALS
7 Medical record fully electronic; care delivery organizationable to contribute to electronic health record as byproductof electronic medical record
0.0%
6 Physician documentation, full clinical decision supportsystem (variance and compliance), full PACS
0.1%
5 Closed-loop medication administration 0.5%
4 CPOE, clinical decision support system (clinical protocols) 1.9%
3 Nursing documentation, eMAR , clinical decision supportsystem (error checking), PACS
8.1%
2 Clinical data repository, controlled medical vocabulary,clinical decision support interface engine, document
imaging
49.7%
1 Ancillaries: laboratory, radiology, pharmacy 20.5%
0 All three ancillaries not installed 19.3%
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Nurses need to developcompetencies ininformatics.
Informatics enables
nurses to use informationand communicationstechnologies in the:
collection of data,
use of information
generation of knowledge tosupport nursing practice
Nursing
Technology
WHY IT IS IMPORTANT?
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the trend in hospitals are computerizingnursing documentations
for effective and efficient data
management such as workload statistics,performance monitoring, etc.
promotes and improves evidence-based
nursing practice and patient outcomes.
WHY IT IS IMPORTANT?
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Nursing informatics enables nurses toquickly move to the synthesis of nursingknowledge and the development of
nursing wisdom. Gone were the days ofmanual documentation that consumesmost of your time, now, more time areused in applying nursing knowledge andwisdom to everyday care because ofinformatics.
WHY IT IS IMPORTANT?
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NURSING INFORMATION SYSTEMS (NIS)includes:
1. Patient Charting
2. Staff Schedules3. Clinical Data Integration
4. Decision Support
WHY IT IS IMPORTANT?
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Patient Charting: A patients vital signs, admissionand nursing assessments, care plan and nursingnotes can be entered into the system either asstructured or free text. These are the stored in a
central repository and retrieved when needed. Staff Schedules: Nurse can self schedule their
shifts using scheduling rules provided in shiftmodules. The shifts can later be confirmed or
changed by a scheduling coordinator or manager.Shift modules are designed to handle absences,overtime, staffing levels and cost-effective staffing.
WHY IT IS IMPORTANT?
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Clinical Data Integration: Here clinical informationfrom all the disciplines can be retrieved, viewed andanalyzed by nursing staff and then integrated into apatients care plan.
Decision Support: Decision support module can beadded to NIS , and they provide prompts andreminders, along with guides to disease linkagesbetween signs/symptoms, etiologies/related factors
and patient populations. Online access to medicalresources can also be made available.
WHY IT IS IMPORTANT?
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Nurse programmers who write or modifycomputer programs for use by nurses
Nurse communicators who work with othernurses to identify computer system needs or toassist in the training and implementation ofthose systems
Informatics nurse managers who manage or
administer information systems Nurse vendor representatives who
demonstrates systems to potential customers
ROLE OF THE NURSE INFORMATICIST
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WHAT CAN AN INFORMATICS NURSE DO?
1. Support nursing work processes usingtechnology
Design systems to match clinical workflows
Telehealth
Homehealth
Ambulatory care
Long-term care
Acute care all specialties
Outpatient settings
Software development
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WHAT CAN AN INFORMATICS NURSE DO?
2. Increase the accuracy and completenessof nursing documentation
3. Improve the nurses workflow Eliminate redundant documentation
4. Automate the collection and reuse of
nursing data5. Facilitate analysis of clinical data
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WHAT CAN AN INFORMATICS NURSE DO?
Admitting a patientAdmission Assessment in computer
Placing orders
Requesting consults Sending data to NIS/HIS
Resolving clinical reminders
These things involve a computer as well Take V/S
Give medications
Consent for surgery
Make the bed
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Prepare/provide workload statistics How many new orders written on Ward X in
a day?
How many medications given on Ward X ina week?
Nurses bypassing BCMA by using Manual
Medication Entry Show me all restraint orders for the past
month
WHAT CAN AN INFORMATICS NURSE DO?
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6. Information system management
7. Documenting patient education
Incorporated into daily charting8. Training/educating
New employees
Student nurses
WHAT CAN AN INFORMATICS NURSE DO?
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COMPETENCIES REQUIRED
Most theorists also emphasize theneed for every nurse whether
employed in the practice or educationsetting, to develop a minimum of a"user" level in computer literacy and
informatics theory.
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LEVEL OF COMPETENCIES
beginner, entry or user level
intermediate or modifier level and;
advanced or innovator level ofcompetency.
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COMPUTER APPLICATIONS
All three levels of competencies -users, modifiers and innovatorsneed to develop a working
knowledge of the followingcomputer programs and processes:
Word processing
Keyboarding
Spreadsheets
Presentation Graphics
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COMPUTER APPLICATIONS
Databases (simple to complex) Desktop Publishing World Wide Web
E-mail programs Expert data systems Multimedia
Telecommunication devices Nursing information systems Hospital information systems
Peripherals (Printers, CD/DVD)
USER LEVEL TECHNICAL COMPETENCIES
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USER LEVEL TECHNICAL COMPETENCIESINCLUDE:
uses word processing applications demonstrates keyboarding skills
uses spreadsheet applications
uses telecommunication devices tocommunicate with other systems
uses e-mail systems to communicate withother health care professionals
uses presentation applications to createslides, displays, overheads(PowerPoint, Corel Presentation, etc.)
uses multimedia presentations
USER LEVEL TECHNICAL COMPETENCIES
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USER LEVEL TECHNICAL COMPETENCIESINCLUDE:
uses internet resources to locate clientsupport groups, online resources
uses sources of data that relate to nursingpractice and care
accesses, enters and retrieves data relatedto client care via available hospital ornursing information systems
uses database management programs todevelop and access databases and tables
uses database applications to enter andretrieve data and information
USER LEVEL TECHNICAL COMPETENCIES
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USER LEVEL TECHNICAL COMPETENCIESINCLUDE:
conducts online and database literaturesearches
uses decision support systems, expertsystems and other aids for clinical decision
making and care planning uses computer applications to document
client care
uses computer applications to plan clientcare, including discharge planning
uses computer applications to enter clientdata (demographic, V/S, physiological data)
USER LEVEL TECHNICAL COMPETENCIES
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USER LEVEL TECHNICAL COMPETENCIESINCLUDE:
uses information management systems forclient education
uses technology based client monitoringsystems
operates peripheral devices (bedside andhand held)
uses operating systems
uses computer peripheral devices (CDROMs, DVD, zip drives)
uses computer technology safely
USER LEVEL TECHNICAL COMPETENCIES
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USER LEVEL TECHNICAL COMPETENCIESINCLUDE:
navigates in Windows environmenteffectively
demonstrates basic technology skills (loadpaper, change toner, unjam printers, print)
MODIFIER LEVEL TECHNICAL
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MODIFIER LEVEL TECHNICALCOMPETENCIES INCLUDE:
applies technology support to provideevidenced based practice
synthesizes data from more than onesource and applies to practice
demonstrates awareness of and ability toaccess data and information from multiplesources
uses decision support systems in practice
MODIFIER LEVEL TECHNICAL
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MODIFIER LEVEL TECHNICALCOMPETENCIES INCLUDE:
accesses pertinent literature resources andincorporates into practice and professionaldevelopment
creates and accesses research and otherdocuments electronically
INNOVATOR LEVEL TECHNICAL
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INNOVATOR LEVEL TECHNICALCOMPETENCIES INCLUDE:
participates in the design and developmentof information systems for nursing practice
develops inventive ways to access dataand interact with information systems
participates in the design and developdesign and development of newapplications for nursing practice
participates in developing new methods fordata and information organization
INNOVATOR LEVEL TECHNICAL
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INNOVATOR LEVEL TECHNICALCOMPETENCIES INCLUDE:
collaborates with information technologyconsultants and other members ofinformation system development team
collaborates, negotiates with and directs
information technology vendors proficiency in diverse computer application
programs
manipulates and enhances nursing datasets
organizes and directs applications ofshared data sets
INNOVATOR LEVEL TECHNICAL
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INNOVATOR LEVEL TECHNICALCOMPETENCIES INCLUDE:
develops data gathering tools andprocesses for literature search access fornurses
develop charting and documentation
templates for use in nursing practice design and development of evidenced
based practice documentation and
processing within practice area
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CERTFICATION AND EDUCATION
HEALTHCARE INFORMATION &MANAGEMENT SYSTEMS SOCIETY(HIMSS)
Certified Professional in Healthcare Informationand Management Systems (CPHIMS 3%)
OTHER 9%
NONE 55%
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SUMMARY
Informatics can make nursing practice visiblein local, national, and international healthcare data sets, thus empowering nurses withinformation to influence policy.
Information is a critical component ofeffective decision-making and high qualitynursing practice. The information and
knowledge gained through nursinginformatics can bring increased awarenessand understanding of nursing and health
care issues.
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SUMMARY
Nursing Informatics is committed tomaintaining a clinical perspective andpromoting research that would bear directlyon improving patient care.
Recognition of Nursing Informatics teamvalue in support of clinical excellence iscrucial to any healthcare organizations
success.
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FRIENDLY ADVICE
Work towards achieving theINNOVATOR LEVEL of technicalcompetency
Keep abreast of latest greatesttechnology trends
Assess newest technology for fitand potential applicability in yournursing profession
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NURSING INFORMATICS ORGANIZATIONS
Ashort list of examples includes:
American Nursing Informatics Association (ANIA)
Australian Nursing Informatics Council (ANIC)
Brazilian Nursing Association Nursing Informatics Group
British Computer Society Nursing Specialist Group
European Nursing Informatics (ENI)
International Medical Informatics Association NursingInformatics Special Interest Group (IMIA-NI)
NURSINFO: Hong Kong
Spanish Society of Nursing Informatics and Internet (SEEI)
Swiss Special Interest Group Nursing Informatics (SIG-NI)
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CONCLUSION
Computers cannot replace anurse, they cannot replace your
intuition, and they cannot replaceyour intelligence and certainly notyour TLC. Nurses cannot become
robots, doing only what thecomputer tells them to do.
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QUOTE OF THE DAY
"Computers are incredibly fast,accurate and stupid. Human
beings are incredibly slow,inaccurate and brilliant.Together they are powerfulbeyond imagination."
- Albert Einstein
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http://nursing-informatics.com
http://ojni.org
http://www.ania.org/http://www.ania.org/ http://www.himss.orghttp://www.himss.org
http://www.cnahttp://www.cna--nurses.canurses.ca
REFERENCES