Nursing

EVERYDAY INFORMATICS

Why Nurses Need to Understand Nursing Informatics DEE McGONIGLE, PhD, RN, CNE, FAAN, ANEF; KATHY HUNTER, PhD, RN-BC, CNE; CAROLYN SIPES, PhD, RN-BC, CNS, APN, PMP; TONI HEBDA, PhD, RN-BC, MSIS, CNE

N ursing informatics is an exciting nursing

specialtydit affects learning environ-

ments, meaningful use, interprofessional

collaboration, patient care settings, strategic plan-

ning, patient satisfaction, and, ultimately, patient

outcomes. Simply put, nursing informatics is the

practice of using nursing science and technology

to enhance the pathway that data take to become

knowledge to improve patient care. Furthermore,

nursing informatics “is the synthesis of nursing

science, information science, computer science,

and cognitive science for the purpose of managing

and enhancing health care data, information,

knowledge, and wisdom to improve patient care

and the nursing profession.” 1(p90)

According to

Hebda and Czar, it is “broadly defined as the use

of information and computer technology to support

all aspects of nursing practice, including direct

delivery of care, administration, education, and

research. The definition of nursing informatics is

evolving as advances occur in nursing practice and

technology.” 2(p6)

Nursing informatics is important to all nursing

specialty areas. It is important for nurses to un-

derstand the relevance of nursing informatics to

their practice. In clinical practice, for example,

nursing informatics can be used to track patient

outcomes, find data trends, and assess workload

and interventions. It also can help develop tech-

nologies, such as apps, to help health care workers

virtually monitor and stay in touch with patients,

improve workflows, and help patients deal with

their diseases. The use of nursing informatics in

nursing education supports virtual teaching and

learning, assessment, analytics associated with

educational outcomes, and the paradigm shift of

bringing the library to the student virtually. Nurse

executives use nursing informatics to help them

with cost containment, improved workflows, deci-

sion support, budgeting tools, and trending costs

and savings. Nursing informatics also can facilitate

and support nursing research by evaluating patient

outcomes, evidence-based practice, standardized

terminologies, and virtual knowledge bases. As

nurses learn nursing informatics, they must learn

to use all information technologies effectively,

recognize the benefits and limitations of this tech-

nology, and integrate them into how they imple-

ment these technologies. In this era of large

amounts of data, nursing informatics competencies

are key to safe, efficient, and quality practice,

and good use of nursing informatics can result in

enhanced patient care outcomes.

THE DATA, INFORMATION, KNOWLEDGE, AND WISDOM PATHWAY

The principles and practices of nursing informatics

allow nurses to understand the process they use

to convert raw data into the wisdom they need to

care for patients. This process is called the data,

information, knowledge, and wisdom pathway.

The data, information, knowledge, and wisdom

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324 j AORN Journal � September 2014 Vol 100 No 3 � AORN, Inc, 2014

pathway is used in all levels of nursing practice. As

nurses access data and process it into information

and knowledge, they build the wisdom necessary

to positively affect the lives of their patients.

Nursing informatics provides the tools and capa-

bilities necessary to enrich the data, information,

knowledge, and wisdom pathway and, therefore,

literally puts the information and knowledge nurses

need at their fingertips.

The pathway begins with data. Data are raw

facts that do not have meaning without context.

After data have been processed to have meaning,

they become information. For information to be

valuable, it must be accessible, accurate, timely,

complete, cost effective, flexible, reliable, relevant,

simple, verifiable,

and secure.

The next step is

for information to

become knowledge,

which is information

that the user can relate

to other information

and can apply to a task

or use to reach an informed decision. As nurses

acquire important knowledge and skills and hone

their ability to observe patients and their environ-

ments (ie, acquiring more data), they learn to place

their observations in proper contexts to generate

information. As their knowledge grows, nurses

can assess the information they have acquired,

communicate applicable findings, and take appro-

priate actions based on these assessments. Nursing

informatics informs and supports these activities.

Wisdom, the final step on the pathway, is the

application of knowledge to appropriate situations

by using insight or intuition while being thoughtful,

judicious, and practical. Nurses need to apply their

knowledge to patients’ situations and rely on their

knowledge, integrated with evidence-based practice,

to enhance patient care. Wisdom uses knowledge

and experience to heighten common sense, per-

ceptions, and the ability to think critically and use

sound clinical judgment. Knowledge and wisdom

are not synonymous, because knowledge includes

others’ thoughts and information, whereas wisdom

is focused on one’s own mind and the synthesis of

one’s own experience, insight, intuition, under-

standing, and knowledge. Wisdom could be

thought of as the foundation of the art of nursing.

PERSONAL IMPORTANCE

The focus of this new “Everyday Informatics”

column is to help nurses understand and implement

the concepts of nursing informatics and optimize

patient care by using health care technology. Ex-

amples of concepts and topics that will fit within

this column include electronic health records (EHR)

personal health records, electronic access to

care (eg, telehealth),

terminologies and

taxonomies (eg, the

Perioperative Nursing

Data Set 3 language),

virtual environments,

social networking and

professional bound-

aries, simulation,

robotics, databases and database management,

analytics, dashboards and benchmarking, accessi-

bility, privacy, meaningful use, and optimization.

Innovative ideas and questions of how periopera-

tive nurses embrace the rapid advancement of

technology and retain the art of the practice at

the same time generates content for this column.

The team members who will be writing this

column with me are Kathy Hunter, Toni Hebda,

and Carolyn Sipes. I asked them each to say why

they believe nursing informatics is important. Their

responses are included here.

Monitoring Patients

Kathy Hunter: Years ago, when I was working

full time nights in the Maryland Shock-Trauma

Unit, we had computer display units in every pa-

tient cubicle that were connected to patient moni-

toring equipment. Laboratory data were provided

directly from the trauma laboratory. Vital signs

Nursing informatics provides the tools and capabilities necessary to enrich the data, information, knowledge, and wisdom pathway and, therefore, literally puts the information and knowledge nurses need at their fingertips.

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EVERYDAY INFORMATICS www.aornjournal.org

data were collected from the monitors. Critical

parameters could be automatically calculated or

requested as needed. Any parameters one wanted

could be graphed in combination on demand. There

also were programs for collecting nursing data (ie,

assessments). This system was pretty primitive

compared with those available today, but even then

I could see the value of having the collected data

displayed across timedwatching trends was a big

part of nurses’ ongoing monitoring. Entering the

data was worth the

effort because the

information we re-

ceived helped keeping

up with patients’ often

rapid physical changes.

It was this realization

that first got me in-

volved in what is now called informatics.

Implementing EHRs

Carolyn Sipes: During the past 11 years, I have

worked as a consultant with several health systems,

both nationally and internationally. Even today, I see

the same issues arise with EHR implementation

regardless of whether they are large or small im-

plementations, or whether they are national or inter-

national implementations. The one consistent theme

throughout all of these implementations is the lack of

communication and understanding between what

information technology department personnel think

should be implemented for clinical staff members

versus what the nurses and other clinical staff mem-

bers really need to complete their day-to-day tasks.

Health systems are becoming better at recognizing the

need and value of the nurse informaticist who can

facilitate the process and communication between the

two specialties.

In the past, and even today, one of the key risks

for project failure in an EHR implementation is

when it is the sole responsibility of the information

technology department to design a system for

clinical users without their input into what is

required for them to successfully complete their

work. Today, the informaticist functions in the role

of a facilitator for information technology and

clinical staff members as well as performs many

other roles. On some projects, informaticists might

work as analysts, or work to interpret and assist

with a workflow design and implementation, or

collect and analyze data that might be used in a

manager’s monthly dashboard report. They provide

shoulder-to-shoulder support for clinical staff

members during the go-live phase of the imple-

mentation. The role

for the informaticist

is expanding even

further as organiza-

tions recognize the

value a nurse infor-

maticist can bring.

An example that

emphasizes the value of an EHR and role of the

nurse informaticist was when both the Cleveland

Clinic and a competitor were implementing the

same EHR system. A patient had tests and radio-

graphs performed at one facility, and a physician

told me how he had cancelled tests and radiographs

he had ordered for the patient because the tests

had already been run at the competing hospital.

Working with the nurse informaticist who facili-

tated the communication between the two hospi-

tals, he said he trusted their results and would use

those instead. The philosophy of using a national

EHR system and adding the skills of a nurse in-

formaticist who understands the functions of both

has saved many health care dollars.

Supporting Nurses’ Work

Toni Hebda: Nurse informatics supports the work

that nurses do. It allows quick access to information

when and where it is needed by the people who

need it to facilitate the delivery of safe, effective

patient care, support administrative decisions, and

enhance the education of nursing students, health

care consumers, and the public through the use of

well-designed and well-used technology. Nurse

informatics provides the tools to make nursing

Informaticists provide shoulder-to-shoulder support for clinical staff members during the go-live phase of electronic health record implementation.

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September 2014 Vol 100 No 3 EVERYDAY INFORMATICS

contributions to health care delivery visible,

support research, and allow virtual real-time

decision making through the use of analytics,

which is a method that allows the discovery and

communication of meaningful patterns in large

unorganized data sets. Nursing informatics is an

exciting area of specialization that focuses on

working smarter, not harder.

Editor’s note: The second edition of the Periop- erative Nursing Data Set (PNDS) was superseded

by the third edition (PNDS 3) in 2011. The PNDS

3 terminology is only distributed through AORN

and AORN Syntegrity� licensed vendors. For questions about PNDS 3 implementation into

the EHR and electronic perioperative record

solutions, please contact the AORN Syntegrity

team via e-mail at [email protected]. AORN

Syntegrity is a registered trademark of AORN, Inc,

Denver, CO.

References 1. McGonigle D, Mastrian K. Nursing Informatics and the

Foundation of Knowledge. 3rd ed. Burlington, MA: Jones

& Bartlett; 2015.

2. Hebda TL, Czar P. Handbook of Informatics for Nurses &

Healthcare Professionals. 5th ed. Upper Saddle River, NJ:

Prentice Hall; 2013.

3. Petersen C, ed. Perioperative Nursing Data Set. 3rd ed.

Denver, CO: AORN, Inc; 2011.

Dee McGonigle, PhD, RN, CNE, FAAN, ANEF,

is the chair of virtual learning environments and

professor of graduate programs at Chamberlain

College of Nursing, Columbus, OH.

Dr McGonigle has no declared affiliation that

could be perceived as posing a potential conflict

of interest in the publication of this article.

Kathy Hunter, PhD, RN-BC, CNE, is the dean,

MSN Indirect Care Tracks, Chamberlain

College of Nursing, Columbus, OH. Dr Hunter

has no declared affiliation that could be perceived

as posing a potential conflict of interest in the

publication of this article.

Carolyn Sipes, PhD, RN-BC, CNS, APN, PMP,

is an associate professor, MSN Program Online,

Chamberlain College of Nursing, Columbus,

OH. Dr Sipes has no declared affiliation that

could be perceived as posing a potential conflict

of interest in the publication of this article.

Toni Hebda, PhD, RN-BC, MSIS, CNE, is a

professor, MSN Program Online, Chamberlain

College of Nursing, Columbus, OH. Dr Hebda

has no declared affiliation that could be

perceived as posing a potential conflict of

interest in the publication of this article.

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