Developing nursing informatics curriculum
Speaker: Ms Imola Jehoda Semmelweis University Faculty of Health Sciences Library Budapest, Hungary Author: Ms Imola Jehoda
Background: The nursing informatics is an important part of the health science curriculum on many levels of nursing programs across the world. Sweeping changes in health care gives urgency to the call to transform nursing curricula so that new competencies could more closely match practical needs.
Aim: This paper is a report of an integrative review of nursing informatics programs. The purpose is to describe the findings of the review to understand the current state of informatics integration within basic nursing curricula.
Data sources: The Ovid CINAHL, Ovid Nursing Database and MEDLINE, EBSCO CINAHL with Fulltext, EBSCO Health Source: Nursing/Academic Edition and ERIC, PROQUEST Nursing and Allied Health Sources, PUBMED electronic databases were searched for the period 1991 – 2008 for research based papers published in English. Manual searching as scrutiny is an additional method.
Findings: Inclusion criteria of the study were defined. The integrative review was conducted and each paper was explored in relation to: design, purposes, sample, outcome measures and results. Comparisons between study findings are difficult to make because of variation in methodology, settings and sample characteristics. There is limited empirical evidence addressing the use of computer technology, skills and competencies.
Conclusions: 1.) The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost effectiveness and safety. 2.) Information literacy and computer literacy are critical to the future of nursing. 3.) Nursing science programs must integrate the contents of complex informatics and competencies into their curricula to prepare nurses for future missions.
Background
After the first attempts to make data processing automatic, there was no doubt that healthcare would be among the important areas of application. As early as in the second half of the 19th century, Florence Nightingale laid down a fundamental principle of her activity, namely that the preparation and execution of every decision needs accurate data. (1) This data collection and processing, in accordance with the development of technology, first happened using punch cards and later punched tapes. The sudden dynamic development of both the creation of theories regarding this and the related functional data processing was given rise to by the invetion and installation of ENIAC (15 February 1946), the predecessor of modern computers. (2) Computers functioning on a large scale, were only usable and economically operatable under conditions of large-scale production, handling large amounts of data. In the 1970s another technological invetion, the silicion chip helped the huge cathode ray tube computers become smaller leading to the spread of computers that could be placed on a desk, which were first known and used as desktop- later as personal computers. The new tool (hardware) speeded up and made possible the development of programs and software needed for the diverse applications and the customizable, service-oriented data management. The first hospital applications are reported to have happened in the 1970s. (3) After the appearance of the software applied in diverse areas of healthcare in the 1980s, the end-user applications were constructed too in almost every field of curing and research. The further development of these - the appearance of the web-based services - was fostered by the faster and faster expansion of the information infrastructure. (4) 1 The work carried out by using tools of information technology and the increasing number of employees gave rise to the attribute ”information society” characterizing society's level of development due to the high amount of research examining the spread of tools and programs in society (culture, recreation, new types of telecommunications channels), The necessity of treating "Nursing Informatics" (hereinafter NI) as a separate discipline first arose at the session of American Nursing Association in 1960. (5) The technical literature started to publish contributions about the topic of "computer applications in nursing" in the 1970s. (6) Numerous research projects were started, and numerous trade associations and academic associations published their views on the subject, predominantly in the USA. Reasearch regarding the application was started and the International Medical Informatics Association held the first conference on NI in 1982. The steady growth of computer applications made it necessary to train the end-user workforce, i.e. to introduce IT subject at every level of nursing- and medical science education. Numerous theoretical models were created about how to compile their contents and curricula, among which the Conceptual Framework of Nursing Informatics published by Graves J. and Corcoran S. in 1989 was exceptionally prescient. According to it NI is nothing but "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." (7) In the same year, Grobe S. was one of the first nurse informaticians to write about the importance of incorporating the competencies into nursing education. (8) The American Nurses Association, in an issue of "Scope of Practice for Nursing Informatics", was the first to define and publish their governing principles, which already included the competencies required at all 3 levels of education. The grouping of these is as follows: * Minimum Information Competencies for the Profession (general level) * Nurse Informatics Practice (bachelor level) * Specialist Practice in Nursing Informatics (12 competencies of master level) These have since been combined into a single document and have benn updated twice. (Last updated in 2008.) (9) The implementation of the programs belonging to the courses is possible in various forms, for which Zytkowski M. mentions some patterns. (10) The further improved structure of Turley J.'s Nursing Informatics Model (1996) is also based on the organic unity of the three part disciplines, "These circles (three intersecting sciences) overlap to form Informatics at their core.", and the planning of NI curricula is still based on them. (11) One of the important milestones in determining and developing the elemental course competencies is the study done in Delphi by the three nurse informaticians (Staggers N, Gassert C, Curran C.). Based on that study there are 22 elemental competencies that need to be acquired, as the integration of knowledges, skills and attitudes in the performance of varions nursing informatics activities. The four major competencies were ordered beside them: beginning nurse, experienced nurse, informatics specialist and informatics innovator. They identify 300 competencies for the four levels of qualification. (12) Besides that, academic research continuosly tried to explore and clarify the contents of NI, which started to develop dramatically in the '90s. They were trying to do so especially with the contents of Nursing Science, aiming for standardization. Saba VK. (13) published his systematizing work, based on a national sample of home health care patients’ records, titled Home Health Care Classification, in which he identified nursing diagnoses and interventions. (14) The new definition of NI by the American Nurses Association was published with the results of this work already included. The definition approached the third area, nursing science complementing the other two areas of science (computer science and information science) as follows: "It encompasses a nursing theory such as the nursing process, a nursing model, and a nursing vocabulary such as the Home Health Care Classification (HHCC)". (15) One of the most detailed progress reports about the NI specialty is contained in the summarizing work „A National Informatics Agenda for Nursing Education and Practice”, (16) which, besides clarifying the academic principles, introduces education models and practical applications and determines the acquisition of educational contents and practical skills, which are based on surveying the needs, as an aim for the future. In the last decade of the last century the usage and support of NI and developed IT began to spread even in the subfields of nursing science, including both the clinical specialties and the patient education. Informatics is
2 foundational to all areas of nursing practice, and the healthcare environment is particularly demanding on nurse practitioners. On the recommendation of Staggers N. (17), the academic foundations of NI were expanded, and the standards regarding the curriculum and accreditation were put into the new edition of ”Scope and Standards of Nursing Informatics Practice”. (18) The outstanding achievement of the 2000s, supporting the NI specialty, was the development of the TIGER Initiative: Addressing Information Technology Competencies in Curriculum and Workforce (TIGER = Technology Informatics Guiding Educational Reform). The summit was attended by the four largest professional associations: - the American Nurses Association (later AACN) representing the nurse practicioners - the National League for Nursing and American Association of Colleges of Nursing representing nurses in education - The American Organization of Nurse Executives representing administrative nurses - and in consideration of the importance of the topic, the American Nurses Association Dean's meeting joined too. The four largest associations represent more than 2 million nurses and at the summit they were joined by 45 smaller specialized professional associations. The accepted initiatives declare that the informatics is a professional key competency in the 21st century. Because of that, the required informatics competencies have to be built into the Nursing Curriculum at every level of education and the usage of the necessary IT tools have to be taught in order to establish these competencies. (29,53,54) The other notable NI statement was made by the National League for Nursing (NLN), titled: ”Preparing the Next Generation of Nurses for Practice in a Technology-Rich Environment: An Informatics Agenda.” It calls on educators to advocate that all nursing graduates have up-to-date skills in computer literacy, information literacy, and informatics. The new position statement requires faculty and curricular initiatives development in information technology. The goal of the federal government was as follows: most Americans should have an electronic healthcare record by 2014. (20) Even in these days, numerous forecasts are created regarding the future of NI. The topic is dealt with in the fullest detail by the Nursing and Informatics for the 21st Century. (21) The authors still accept and carry on the concept of NI, but they define the contents of the concept in a wider range. (Not just NI, but Nursing and Informatics) This is also revealed by an interview made with one of the authors, Delaney CW. (22) ”… informatics includes the core that combines information science and computer science; this core is coupled with a discipline [for example nursing]. It is important that all disciplines have their discipline – specific informatics, whether it is pharmacy, medicine, nursing or public health. Taken together, there’s also a common health informatics core that we all share.” … ”The (nursing) educational need right now is for every nursing graduate, from curricula from all nursing programs, to graduate with computer and informatics competencies. They are then prepared for practice, teaching and research in this world that is so strongly defined by technology and informatics.” We conclude that NI plays an essential role in the future directions of healthcare, and in the relationship between nurses and information technology.
Methods
Aim This paper is a report of an integrative review of nursing informatics programs. The purpose is to describe the findings of the review to understand the current state of informatics skills – computer literacy and information literacy – integration of nursing science curricula at all levels.
Design An integrative review method was used to identify the literature published to determine the state of knowledge and development of nursing informatics, particularly to imply health- and nursing informatics research, theoretical matters and implementation in nursing science.
3 Inclusion / exclusion criterias The papers reviewed • were published between 1991 and 2008 • evaluated or assessed skills of nursing informatics • examined nursing informatics educational programs in the context of nurse education • included nursing informatics curriculum development programs • had empirical evidence: implementation of the nursing informatics competencies in the practice • included a sample of nurses from all levels and types of nursing education • could be implemented in any country • had full texts accessible Papers were excluded if they were • not available in english • conference or congresse matters, published in proceedings • dissertations • books, book chapters.
Search methods Literature searches were conducted November to December 2008 and January to 24 March 2009. Eight electronic databases were searched: • OVID MEDLINE • OVID CINAHL • OVID Nursing Database • EBSCO CINAHL with Full Text • EBSCO ERIC • EBSCO Health Source: Nursing/Academic Edition • PROQUEST Nursing and Allied Health Sources • PUBMED
The search started with the permutation of ”Health Sciences Education or Nursing Education” AND ”Nursing Informatics”. MeSH headings and other specific database headings, relevant keywords, free text terms were combined as appropriate to focus the search on the specific topics. These searches led to a variety of papers focusing on several fields of nursing education. To avoid excluding relevant articles, the general subject terms were explored without limit, and specific subject terms were added:
Search outcome Databases Hits • OVID MEDLINE 46 • OVID CINAHL 76 • OVID Nursing Database 65 • EBSCO CINAHL with Full Text 76 • EBSCO ERIC 7 • EBSCO Health Source: Nursing/Academic Edition 5 • PROQUEST Nursing and Allied Health Sources 14 • PUBMED 616
Titles were cross-checked for duplicates and relevance to the focus of the review. 4
Figure 1. Search Procedure Flow Chart
Full references retrieved from eight databases n=905
Refused by title n=531
Full abstracts screened n=374
Refused by abstract n=211
Full papers obtained n=163
Refused full paper n=47
Full literature included in the review n=116
Reviewed theoretical literature Reviewed research literature n=77 n=39
Results
In the review, I evaluated 116 academic publications published between 1991 and 2008. The primary criterion of the separation and grouping was based on whether the publications were based on research or just described and popularized theories. As a result of this, I found 39 research based publications, out of which 11 elaborate several synthetized topics. 9 out of them are connected to two topics and 2 are connected to three topics. There were 77 publications digesting the theoretical basics. Several topics are touched upon by 12 of them, of which 9 are connected to two, and 3 are connected to three topics, touching on the implementation of the results too. One of the reasons for this is that usually, after reviewing the NI programs, most of the authors immediately reveal the possibility or even the necessity of the development of the curriculum. The presentation of the results - in accordance with the selection criteria - goes by the synthetized topics, separating the research based and the theory based publications, but featuring them from all perspectives (several times) if their subject or method calls for it.
Synthetized themes
I. Reviewed literature discussing the evaluation fields of Nursing Informatics (NI)
5 I / A. Research based literature
Number of First Author Focus Data collection methods references alphabetical (date) 23 Bakken S et al. NI research agenda: 2008 – 18. Interdisciplinary research (2008) 121 Carty B et Findings from a national study of Research survey al.(1998) nursing education 24 Charters KG NI: outcomes, quality improvement Comparison of sources national (2003) datas 25 Craig A et al. Impact of an information literacy Combined qualitative and (2007) programme quantitative techniques in pre- and post test 26 Desjardins KS et Effect on an informatics for Measurement of informatics al. (2005) Evidence -based Practice competencies by three research Curriculum questions 109 Edwards PA. Evaluation of learning and program Pilot study: Questionnaires, (2005) effectiveness. interviews, standardized scales 27 Eley R et al. National Survey of Australian Self-administered postal survey (2008) Nurses: information and computer technology education 105 Gaumer GL et al. Use of information technology by Survey: statistical analysis of nurse (2007) advanced practice nurses practitioner program 28 Guenther JT. NI : mapping the literature Five core journals references were (2006) analyzed for 1996 - 1998 29 Hart MD. (2008) Informatics competency and Systematic literature review: total of development: within the US 17 citations were selected nursing population workforce 102 Hwang HG et al. The measurement of initial nursing Questionnaire (2008) NI literacy for clinical nurses 30 Jiang WW et al. Computer competencies for the Delphi technique (2004) nursing profession 31 Ku YL et al. Efficacy of integrating information Comparative study, based on Likert (2007) literacy education Scale 32 Lin JS et al. An exploration of NI competency Cross sectional research study: based (2007) and satisfaction related to network online questionnaire education 33 Maag MM. A National Study: Nursing Questionnaires, Technology Attitude (2006) Students’ Attitudes Toward Scale Technology 34 McDowell DE et Computer literacy in baccalaurate Self-reported questionnaires al. (2007) nursing students during the last 8 evaluation study years 35 McNeil BJ et al. A US Survey: Nursing information Based three online research (2003) technology knowledge, skills questionnaire 266 of 672 programs completed the survey. 36 McNeil BJ et al. US National Survey: NI knowledge Online survey of deans/directors of (2005) and competencies in nursing 266 baccalaureate and higher education programs nursing programs 37 McNeil BJ et al. Computer literacy study The survey is based 37 discrete (2006) quantitative questions 38 Ragneskog H et Competence in NI in Sweden Competence questionnaires, al. (2006) separated by students vs. nursing educators 6 39 Saranto K et al. NI in nursing education: a Specially designed questionnaire (1998) challenge to nurse teachers with three open–ended questions 40 Tarrant M et al. Curricular approach to improve the Evaluation studies based pre- and (2008) information literacy and academic post test writing skills 41 Thompson BW et National Survey: informatics in the Self – reported questionnaires al. (2008) nursing curriculum 42 Wallace MC et Evaluation: Teaching information Comparison: Pre- and post- al. (2000) literacy skills programme questionnaires 43 Wharrad H et al. Health informatics skills in nurse Evaluation based questionnaire (2002) education 44 Wharrad H et al. Putting post-registration nursing Questionnaire from use of web site (2005) students on-line and discussion forum
I / B. Theoretical based literature
Number of First Author alphabetical (date) Focus references 45 Fetter MS. (2008) Enchancing Baccalaureate Nursing Information Technology Outcomes : overview of NI competencies 46 Heimar FM. (2005) NI: Current issues around the world 119 Hovenga EJ. (2000) The article represents the health information education in 20 countries of five continents 47 Nagelkerk J et al. (1998) NI: overview of the essential factors for development of educational programs 106 Orness LL et al. (2007) BSN curriculum evaluation of NI content 6 Ozbolt JG et al. (2008) NI: brief history and advance in the USA 48 Saba VK. (2001) NI: overview and discussion of development 49 Saranto K et al. (2004) Literature review: information literacy 50 Simpson RL. (2007) NI: the economics of education – costs of informatics-trained nurses 51 Skiba DJ. (2004) Redesigning nursing curricula for Evidence Based Practice 52 Skiba DJ. (2004) Informatics competencies for beginning nurses 53 The TIGER = Technology Informatics National Nursing Leadership Organizations USA Guiding Education Reform Initiative Recommendations (2004) 54 Weawer CA et al. (2006) ANI Connection: TIGER Initiative 55 Willmer M. (2005) Promoting practical clinical management learning: use of ICT skills 10 Zytkowski M. (2003) NI: Contemporary Nursing Practice
The number of publications connected to the first synthetized topic is 41, out of which 26 are research based and 15 are theory based. 5 of the 26 research based publications are extensive national surveys (27,33,35,36,41) and their geographic distribution is as follows: 4 are from the USA and 1 is from Australia. One of the studies presents the tasks of NI, and the vision of its accelerated development in the future, based on the evaluation of the foregoing results. (23) The other publications evaluate the individual fields of NI using the various research and sampling methods listed in the synthesis. The distribution of the publications related to the specialties evaluated is as follows: - Information Literacy (25,40,42) - Informatics and Computer Literacy, Computer Competencies (29,30,34,37,43,44) - Examination of the place and situation of NI in the system of Nursing Education (24,28,32,38,39).
7 The 15 theory based, descriptive publications provide the synthesis of technical literature regarding to the past, present and future of NI.(6,47,48) Most of them trace the course of development of the discipline until now, presenting the opportunities of develompent in the future and an insight into NI education all over the world. (10,46) Several authors (53,54) deal with reviewing and popularizing the TIGER Initiative and the application of competencies recorded in it in both education and practice. The new methods (Evidence-Based Practice) appearing with the development of nursing science suggests the necessity of redesigning the curriculum. (45,51,52) The information literacy, one of the subfields of NI, is reviewed and evaluated in the form of literature review (49). Several studies emphasize that it is important to learn using advanced IT tools in clinical practice within the confines of the NI subject. (45,47,48,55)
II. Reviewed literature discussing exposition of Nursing Informatics (NI) educational programs in the context of nurse education II /A. Research based literature
Number of First Author Focus Data collection methods references alphabetical (date) 128 Arnold JM. NI: educational needs Survey: 497 respondens, 23 content (1996) areas, 3 subsamples; nurse educators, nurse managers and informatics nurses 100 Berkow S et al. Nursing competencies in the National Survey: from new graduate (2008) safe and effective nursing nurses deemed essential competencies practice 56 Bird D et al. The role of library and Discussion and evaluation of an (1998) information services in experience for curriculum planning b y curriculum planning questionnaire 57 Chastain AR. Information technology Comparison and analysis by Staggers (2002) integration into the curriculum questionnaire 26 Desjardins KS Effect on an informatics for Comparison the types of computer skill et al. (2005) Evidence-based Practice competencies by competency scale and Curriculum scores 58 Jacobs SK et al. A Curriculum integrated Survey and evaluation of information (2003) approach: Information literacy literacy competencies by pre- and post test 114 Rosenfeld P et Pilot project: develop the Comparison and evaluation by pre-and al. (2002) information literacy skills of post tests staff nurses 59 Saranto K et al. Developing the information Three-round Delphi postal survey (1997) technology syllabus 60 Shorten A et al. Developing information literacy Comparison and evaluation by pre-and (2001) postprogramme questionnaires 40 Tarrant M et al. Curricular approach to improve Comparison of pre-, post-, and final (2008) the information literacy and information literacy scores by academic writing skills demographic indicators 41 Thompson BW National Survey: Informatics in Curriculum integration methods: if the et al. (2008) the nursing curriculum informatics is integrated and if the content is integrated (tables) 61 Yee CC. (2002) Identifying information Evaluation study: Rossett’s needs technology competencies analysis model by interview needed 44 Wharrad HJ et Putting post-registration nursing Discussion optimal use of on-line al. (2005) students on-line resources by Salmon’s 5 stage model
8 II / B. Theoretical based literature
Number of First Author Focus references alphabetical (date) 62 Barnard A et al. (2005) Developing Information Literacy Skills 63 Booth RG et al. (2006) Educating the eHealth Professional Nurse 115 Carty B et al. (2001) The development of a graduate program in nursing informatics 64 Curran C. (2003) Informatics competencies for nurse practitioners 98 Curran C. (2008) Informatics content and competencies 99 Gassert CA. (2008) Master list of informatics competencies for nurses 65 GoossenWTF et al. Changes in NI education: Seven years experience (1997) 135 GoossenWT et al. NI education for masters level nursing practice (1998) 66 Ivory C. (2008) Informatics competencies for Perinatal Nurses 67 Kelly M. (2006) Program design for Nurse Informaticians 116 Marini SD. (2000) Planning, developing, integrating and evaluating NI programs 103 Mays CH et al. (2008) Suggestions for maintaning information technology competency 122 McGonigle D et al. Definition the new discipline and propose for new courses (1991) 68 Morgan PD et al. Use of Information Literacy Skills: Interdisciplinary Perspectives (2007) 113 Nagle LM et al. (2004) The fondings of a national study from current state of informatics integration within basic nursing curricula. 123 Noll ML et al. (1993) Integrating nursing informatics into a faculty nurses 69 Sackett K et al. (2005) Incorporating Healthcare Informatics in Nursing Education 111 Pelletier D et al. (2004) The article describes the teaching of Information Management 70 Pravikoff DS. (2006) A culture of Evidence Based Practice and Information Literacy 130 Saba VK et al. (1997) Full integration of NI education at all levels at academic institutions and in practice 71 Sherwood G et al. Quality and safety curricula in nursing education (2007) 72 Simpson RL. (1994) NI core competencies 110 Smedley A. (2005) Use and integration of ICT technology skills into nursing program 112 Smith K et al. (2004) NI competencies development, Healthcare informatics certifications and ethical standards 73 Staggers N et al. Informatics competencies for Nurses at Four Levels of Practice (2001) 129 Travis LL. (1997) The integrated curriculum is effective in familiarising students with informatics 74 Travis LL et al. (1998) An Innovative NI Curriculum 127 Vanderbeek J et al. Bringing NI into the undergraduate nursing education programs (1994) 75 Verhey MP. (1994) Information Literacy an Undergraduate Nursing Curriculum 76 Wallace MC et al. Information Literacy: a curriculum integrated approach (1999)
The number of publications examining the place and structure of NI in the system of nursing education is 43. 13 of them are research based, whereas 30 are theory based. In comparison with the previous synthetised topic, we conclude that the number of research based studies is much lower, i.e. the processing method is rather theoretical, and the approach is descriptive. The reason for this is that the NI program reviews, the curriculum descriptions and the presentation of their connection to the system of nursing education rather allows an interpretative, theoretical approach to the topic.
9 4 of the research based publications are identical to the ones introduced in the first topic, because their authors, with a complex approach to the topic, extend the evaluation to reviewing the NI programs and examining the acceptance of their contents. (26,40,41,44) This complexity especially applies to the study of National Survey: Informatics in the Nursing Curriculum (41). As its early premise, we can mention the study made by Arnold JM. (128) arguing for the need for professional nurses in NI education. From the further studies, 3 engage in the new methods of approaching the education of Information Literacy and the itegration of library information services into the curriculum. (56,58,60) The necessity of learning about the competencies related to Information Technology and integrating them into the curriculum is evidenced by the studies of several authors. (44,57,59,61,100) From the theory based publications, the Informatics competencies for nurses at four levels of practice from Staggers N et al.(73) and Curran C.'s extensive analitical works got into the technical literature as widely accepted principles and guidelines. These authors, complementing each other, demonstrated the necessary NI competencies starting from training through the entire professional career. Prior to them, there were already some attempts at mapping separate set of NI competencies and integrating them into the system of Nursing Education. (65,72,74,122,123,130) McGonigle D et al.'s (122) study written in 1991 was a pioneer that defined the new discipline and suggested starting the new courses. In 1993, Noll M et al. (123) already presents the integration of the new subject and in 1994 Simpson presents that of the NI key competencies into faculty courses. In 1997, Saba VK et al.'s (130) guidelines set forth and urged the full integration of NI for medical professionals learning, practicing and working at all levels of higher education, and analyzed his experience of the efficiency of the courses integrated into the system of Nursing Education in the development of the students' IT skills. Their usefulness was also confirmed in the publications of Travis LL.(74,129). The continous changing of the set of competencies according to the develompent of informatics as a precondition of the development of the NI curriculum is the subject of the analytical studies of Curran C.(98) and Gassert CA. Pelletier (111), Sherwood (71) and Smedley (110) demonstrate the diverse geographic potentials of further development. Besides the extensive recommendations for competencies and education programs in relation to all areas of education and work, there were numerous other studies that elaborated curricula from a number of areas of education or work. (63,66, 67,69,113,114,115,127,135) These inform us of the development of the general curriculum of Information Literacy (68,75,76), the curriculum related to Evidence Based Practice and the development of the Competency of Information Technoligy.
III. Reviewed literature discussing NI curriculum development
III /A. Research based literature
Number of First Author Focus Data collection methods references alphabetical (date) 56 Bird DR. The role of library and Analysis of the contribution of LIS professionals (1998) information services (LIS) to the curriculum: modular curriculum in curriculum planning development, survey of the needs of educationalists and promote study packages 57 Chastain AR. Information technology Curriculum development by analysis of (2002) integration into the qualitative findings: comparison of information curriculum technology use students, faculty members and employers 58 Jacobs SK et A curriculum integrated Proposal a new model for integrating information al. (2003) approach: Information literacy into the master’s nursing program literacy competencies and Evidence-Based Practice 59 Saranto K et Developing the Recommendations for teaching information al. (1997) information technology technology in nurse education by three-round syllabus in nursing Delphi survey education 10 60 Shorten A et Developing information Comparison: in level of confidence before and al. (2001) literacy: skills to evidence- after the new curriculum-integrated information- based nursing literacy programme 40 Tarrant M et Curricular approach to On the basis of evaluation and analysis of al. (2008) improve the information information literacy and academic writing skills literacy and academic competencies is an urgent need to develop writing skills information literacy standards and basic competencies for practising nurses 61 Yee CC. Identifying information By using Rossett’s needs analysis model is (2002) technology competencies realization: the work-related Information needed Technology systems must be included in the curriculum 43 Wharrad H et Health informatics skills in Universitas 21 project: integration of health al. (2002) nurse education informatics into the curriculum: interprofessional and shared learning between the participating institutions 44 Wharrad H et Putting post-registration Results suggest: all students would need to al. (2005) nursing students on-line develop both skills and confidence in utilising computer technology and on-line learning
III / B. Theoretical based literature
Number of First Author Focus references alphabetical (date) 125 Axford R et al. (1994) Knowledge development and dissemination in NI 62 Barnard A et al. (2005) Integrating information literacy into nursing curricula and nursing education 77 Barton AJ. (2005) Information competencies in a community practice 117 Betts H et al. (2000) The projects demonstrate the increasing in teaching information management and technology 63 Booth RG. (2006) Recommendation: redesign of nursing curricula in relation to NI 98 Curran CR. (2008) Informatics content and competencies 78 Feeg VD. (2004) Nursing Curriculum Reform Campaign 99 Gassert CA. (2008) Nurses preparation to use new information technologies 118 Hebert M. (2000) Summarizes key points – development of NI competencies - of a National (Canadian) NI Projects 79 Hinegardner PG et al. NI programs at the University of Maryland (1994) 126 Kooker BM et al. NI educating for tomorrow’s challenge (1994) 134 Nagelkerk J et al. N I : New model is presented that identifies six essential factors (1998) 69 Sackett K et al. (2005) Application of healthcare informatics into the strategic planning process in nursing education 71 Sherwood G et al. Quality and safety competency (6 quality and safety competencies (2007) are defined) development in nursing education 104 Sockolow P et al. Use of project management skills in NI project (2008) 74 Travis LL et al. (1998) The basic components of the innovative NI curriculum: course descriptions and evaluation 11 Turley JP. (1996) New model for the development of NI based curriculum 75 Verhey MP. (1999) Development and evaluation of the information literacy curriculum strand 76 Wallace MC et al. Models and programmes for information literacy education:
11 (1999) description of the curriculum-integrated programme 80 Westmoreland et al. Health system nurse specialist curriculum (2002)
The number of publications regarding this (III.) topic is 29. Their distribution is as follows: 9 research based and 20 theory based publications. The close connection with the previous (II/A.) topic analyzed is shown by the fact that 8 of the 9 research based publications are connected to it, while only 1 is connected to the first (I/A.) topic. The complex approach of the 8 research based publications is shown by the fact that their authors - applying each other's achievments - also make their own suggestions on developing the NI curriculum. The study (43) also having some bearings on the first topic (I/A.), after reviewing and evaluating the health informatics skills in nurse education, also makes a suggestion to develop the curriculum along this line.
From the 20 theory based publications, 9 are also connected to the studies of the previous topic (II/B.), while the other 11 introduce the following main areas of curriculum development: - NI maturing into a discipline, the description of the first programs and forms of education in 1994 (79), - the forming and the principles of development of the core curriculum of NI by Axford R et al.(125), and the further levels of curriculum development within the confines of the new models by Turley JP (11) in 1996 and Nagelkerk J et al. (134) in 1998 - the elaboration and review of the NI competency in Canada too, in the extensive study titled National Education Strategy to Develop NI Competencies (118), - furthermore as the new tool of competency and curriculum development - linked to the individual nursing science subfields - the potential of the project potential is discussed by several authors (77,80,104,117).
IV. Reviewed literature discussing: Implementation of the NI competencies in the practice IV / A. Research based literature
Number of First Author Focus Data collection methods references alphabetical (date) 81 Connors HR et al. Academic- business partnership: the Pilot project: IT integrated (2002) SEEDS (Simulated E-hEalth Delivery curriculum evaluation by System) project questionnaire 82 Honey M et al. Improving library services: case study Quantitative evaluation by (2006) questionnaire, qualitative evaluation by interviews 83 Informa Nurses computer use Comparative survey from Internet Healthcare (2008) use for health information 84 Orness LL et al. Implication of computer Research questionnaire for the all (2007) competencies for nursing education courses in a BSN program 132 Saranto K et al. The nursing students want to learn Survey by questionnaire (1997) more from information technology
IV / B. Theoretical based literature
Number of First Author alphabetical (date) Focus references 85 Abrahamsen C. (2003) Informatics challenge: patient safety 63 Booth RG. (2006) See also II / B. 63. 124 Cassey MZ et al. (1994) New trends influencing NI 86 Cheek J et al. (1998) Resources for nurses as lifelong learners 98 Curran CR. (2008) Handheld Devices 87 Delaney C. (2001) New frontiers in NI 12 88 Dragon N. (2008) Electronic health strategy: is this the end of paper based records 99 Gassert CA. (2008) Health care information technologies 107 Gassert CA et al. (2007) Discussion the implementation strategies used 89 HIMSS (Healthcare Information and Management Specific roles, enchancing nursing Systems Society) Nursing Informatics Awareness practice Task Force (2007) 90 Jenkins ML et al. (2006) National Health Information Infrastructure, implications 131 Lewis D et al. (1997) The place of strategic planning in NI 101 McGowan JJ. (2008) Commentary: Information technology transformation 108 Monsen KA et al. (2006) Implementation of a sound data quality infrastructure for nursing documentation 91 Nagle LM. (2007) Infoway: Canada-wide health infrastructure 120 Nesler MS et al. (1998) Results in a distance-based master’s degree and certificate program in NI 133 Ribbons RM. (1998) Use of computers as cognitive tools in nurse education 92 Simpson RL. (2005) New information technology for nursing profession 93 Skiba DJ. (2007) Faculty 2.0: Faculty Development Opportunities 94 Skiba DJ. (2008) New Tools and Opportunities in the nursing practice 95 Skiba DJ et al. (2008) Transformation of the new information technologies into nursing education 96 Smith Glasgow ME et al. (2005) Benefits and costs of NI projects implementations 97 Sweeney M et al. (2008) Successfull online continuing education programs
In this topic analyzed there are altogether 28 publications. 5 of them are research based and 23 are theory based. Each of the 5 research based studies - irrespective of the previously discussed topics and independently of one another - engages in the practical implementation of competencies. The earliest (1997) is Saranto K et al.'s (132) opinion poll based study, which confirms that nursing students need a more detailed familiarization with the information technologies within the confines of NI education. Further research introduces the SEEDS developer project (81), the expansion of library services and the increase of its standards in a case study (82), the nurse computer use (83) and the integration of computer skills into the Nursing Education curricula. From the 23 theory based publications, 3 discuss their subjects in a complex manner (63,98,99), because all three are devoted to the place and role of the NI curriculum as well as the possibilities of curriculum development in the Nursing Education system. After this they demonstrate the methods of implementing these factors, even directly touching upon the Handheld Devices if needed (98). The questions and possibilities of practical utilization arose already in the early years of the introduction of NI as an independent discipline. Several studies were devoted to the effects of the new trends brought about by the computerization of NI between 1994 and 2000 (124). Following that the utilization of the tools of NI arose in strategic planning (131), research on the methodology of lifelong learning (86), the development of the mobile learning systems (120) as well as the analysis of the effects of their cognitive functions (133). Later studies on the elaboration of the general theory of implementation grew in numbers. Besides unfolding the new frontiers (87) it is also important to integrate the new information technologies (92). This subject was 13 handled with high priority by Jenkins ML et al. (90) in 2006, who reviewed and analyzed the National Health Information Infrastructure and the necessity of its integration into nursing practice. In the 2000s, with the appearance of the more and more numerous and advanced applications, the technical literature of implementing and integrating these novelties into NI has also grown. The implementation strategies and the possibilities of their utilization is reviewed by Gassert CA et al. (107) Skiba DJ. (93,94,95) analyzes the utilization of the tools Faculty 2.0 on the model of Web 2.0 extensively and with a great breadth of view, introducing to the practicioning technicians the new pool of tools of communication and the possibilities of application. Eventually he demonstrates the necessity to include them in the nursing curricula and also mentions some methods of that. In the other publications the authors introduce the following special fields and possibilities of application: - patient safety (85) - sound data implications (108) - HIMSS (Healthcare Information Management and Systems Society) Statement (89) - introduction of new electronic patient records (end of paper based medical record era, 88) - demonstration of the Infoway Canada project (91) - and succesfull on-line education programs (97). The cost-volume-profit analysis of the implementation of the NI projects above (96) summarizes and proves the necessity and importance of their inclusion. The most important is to raise the standards of professional work, which would be beneficial not only for technicians but, besides them, the much larger number of consumers of medical services, making the social benefits invaluable.
Findings The intent of this review is to draw public attention in the author's country to the importance of the tuition of NI. The major areas of NI:– computer literacy, information literacy, nursing and health sciences implications – already constitute separate parts of the Nursing Education curriculum, but an integrative minded, competency based education is just emerging within the confines of the curriculum reform of Hungarian higher education. The author wishes to contribute to the successful realization of this by aiming to summarize and analyze the publications of the international technical literature, which had significant effects on and achievements in the evolution and development of the NI curriculum The year 1991 was chosen as the starting date of the review. Although Graves and Corcoran (136) had created the complex definition of NI already in 1989, it got internationally accepted as a separate discipline only after its application in databases, which marked the acceptance of the use of the concept. NI as it was entered into the MEDLINE databases as a separate subject-heading at this time. Before that the subject-headings
14 - national studies, surveys, initiatives and proposals of professional associations have continuosly been created and published in the USA to modernize the NI education and make it extensive (27,33,35,36,41,53,54) - the Information Literacy curriculum and competencies of NI curriculum are being developed continuosly (56,58,60,62,68,70,75,76) - the curriculum and competencies of Computer Literacy subfield are also being developed (57,59,61,66,73,77) - the contents and competencies of Healthcare Information Literacy are being developed (63,69,80)) - from Web 2.0 to Faculty 2.0, the example of implementing and adapting modern IT tools to the NI curriculum leads to the future (Skiba DJ, 93) • 2008 – the study of Bakken S et al. (23) delineates the diversity of the prospective changes embedded into the image of the future of NI research. He selects three of them when dealing with the development trends of three areas - Genomic Health Care, Shifting Research Paradigms, Social (Web 2.0) Technologies - in detail. In the part titled Key Components of a Nursing Informatics Research Agenda for 2008-18 – making a comparison with the seven prioritized fields of NI research between 1992 and 1996 - he examines their current and predictable future situations. ”These influences are illustrated using the significant issue of healthcare associated infections (HAI).” From the major conclusions, we should emphasize the extension of the interdisciplinarity of the research, including the utilization of genomical and environmental data. The redesigning of nursing practice, the development of the theory of NI and the development of the patient's and caregiver's knowledge-based cooperation are necessary in the field of Nursing Science. They all have to be complemented by the application of the new technologies and the inclusion of innovative evaluation methods, which also takes the organic connection of human-computer interface factors into consideration.
Conclusions Reviewing the major stages of the development of NI we can conclude that NI in fact is a: • continuosly developing discipline, • whose development is closely related to the current state of development of ICT • and the social impregnation of the ICT tools, i.e. the extensive integration of the social web technologies into the sphere of scientific and technical applications • for this NI is critical to the future of nursing, • nursing science programs must integrate the contents of complex informatics and competencies into their curricula to prepare nurses for future missions.
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