EVERYDAY INFORMATICS Why Nurses Need to Understand 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

ursing informatics is an exciting nursing improve workflows, and help patients deal with specialtydit affects learning environ- their diseases. The use of nursing informatics in Nments, meaningful use, interprofessional nursing education supports virtual teaching and collaboration, patient care settings, strategic plan- learning, assessment, analytics associated with ning, patient satisfaction, and, ultimately, patient educational outcomes, and the paradigm shift of outcomes. Simply put, nursing informatics is the bringing the library to the student virtually. Nurse practice of using nursing science and technology executives use nursing informatics to help them to enhance the pathway that data take to become with cost containment, improved workflows, deci- knowledge to improve patient care. Furthermore, sion support, budgeting tools, and trending costs nursing informatics “is the synthesis of nursing and savings. Nursing informatics also can facilitate science, information science, computer science, and support by evaluating patient and cognitive science for the purpose of managing outcomes, evidence-based practice, standardized and enhancing data, information, terminologies, and virtual knowledge bases. As knowledge, and wisdom to improve patient care nurses learn nursing informatics, they must learn and the nursing profession.”1(p90) According to to use all information technologies effectively, Hebda and Czar, it is “broadly defined as the use recognize the benefits and limitations of this tech- of information and computer technology to support nology, and integrate them into how they imple- all aspects of nursing practice, including direct ment these technologies. In this era of large delivery of care, administration, education, and amounts of data, nursing informatics competencies research. The definition of nursing informatics is are key to safe, efficient, and quality practice, evolving as advances occur in nursing practice and and good use of nursing informatics can result in technology.”2(p6) enhanced patient care outcomes. Nursing informatics is important to all nursing specialty areas. It is important for nurses to un- THE DATA, INFORMATION, KNOWLEDGE, derstand the relevance of nursing informatics to AND WISDOM PATHWAY their practice. In clinical practice, for example, The principles and practices of nursing informatics nursing informatics can be used to track patient allow nurses to understand the process they use outcomes, find data trends, and assess workload to convert raw data into the wisdom they need to and interventions. It also can help develop tech- care for patients. This process is called the data, nologies, such as apps, to help health care workers information, knowledge, and wisdom pathway. virtually monitor and stay in touch with patients, The data, information, knowledge, and wisdom

http://dx.doi.org/10.1016/j.aorn.2014.06.012 324 j AORN Journal September 2014 Vol 100 No 3 Ó AORN, Inc, 2014 EVERYDAY INFORMATICS www.aornjournal.org pathway is used in all levels of nursing practice. As are not synonymous, because knowledge includes nurses access data and process it into information others’ thoughts and information, whereas wisdom and knowledge, they build the wisdom necessary is focused on one’s own mind and the synthesis of to positively affect the lives of their patients. one’s own experience, insight, intuition, under- Nursing informatics provides the tools and capa- standing, and knowledge. Wisdom could be bilities necessary to enrich the data, information, thought of as the foundation of the art of nursing. knowledge, and wisdom pathway and, therefore, literally puts the information and knowledge nurses PERSONAL IMPORTANCE need at their fingertips. The focus of this new “Everyday Informatics” The pathway begins with data. Data are raw column is to help nurses understand and implement facts that do not have meaning without context. the concepts of nursing informatics and optimize After data have been processed to have meaning, patient care by using health care technology. Ex- they become information. For information to be amples of concepts and topics that will fit within valuable, it must be accessible, accurate, timely, this column include electronic health records (EHR) complete, cost effective, flexible, reliable, relevant, personal health records, electronic access to simple, verifiable, care (eg, telehealth), and secure. terminologies and The next step is Nursing informatics provides the tools and taxonomies (eg, the for information to capabilities necessary to enrich the data, Perioperative Nursing become knowledge, information, knowledge, and wisdom pathway Data Set3 language), which is information and, therefore, literally puts the information virtual environments, that the user can relate and knowledge nurses need at their fingertips. social networking and to other information professional bound- and can apply to a task aries, simulation, or use to reach an informed decision. As nurses robotics, databases and database management, acquire important knowledge and skills and hone analytics, dashboards and benchmarking, accessi- their ability to observe patients and their environ- bility, privacy, meaningful use, and optimization. ments (ie, acquiring more data), they learn to place Innovative ideas and questions of how periopera- their observations in proper contexts to generate tive nurses embrace the rapid advancement of information. As their knowledge grows, nurses technology and retain the art of the practice at can assess the information they have acquired, the same time generates content for this column. communicate applicable findings, and take appro- The team members who will be writing this priate actions based on these assessments. Nursing column with me are Kathy Hunter, Toni Hebda, informatics informs and supports these activities. and Carolyn Sipes. I asked them each to say why Wisdom, the final step on the pathway, is the they believe nursing informatics is important. Their application of knowledge to appropriate situations responses are included here. by using insight or intuition while being thoughtful, judicious, and practical. Nurses need to apply their Monitoring Patients knowledge to patients’ situations and rely on their Kathy Hunter: Years ago, when I was working knowledge, integrated with evidence-based practice, full time nights in the Maryland Shock-Trauma to enhance patient care. Wisdom uses knowledge Unit, we had computer display units in every pa- and experience to heighten common sense, per- tient cubicle that were connected to patient moni- ceptions, and the ability to think critically and use toring equipment. Laboratory data were provided sound clinical judgment. Knowledge and wisdom directly from the trauma laboratory. Vital signs

AORN Journal j 325 September 2014 Vol 100 No 3 EVERYDAY INFORMATICS data were collected from the monitors. Critical work. Today, the informaticist functions in the role parameters could be automatically calculated or of a facilitator for information technology and requested as needed. Any parameters one wanted clinical staff members as well as performs many could be graphed in combination on demand. There other roles. On some projects, informaticists might also were programs for collecting nursing data (ie, work as analysts, or work to interpret and assist assessments). This system was pretty primitive with a workflow design and implementation, or compared with those available today, but even then collect and analyze data that might be used in a I could see the value of having the collected data manager’s monthly dashboard report. They provide displayed across timedwatching trends was a big shoulder-to-shoulder support for clinical staff part of nurses’ ongoing monitoring. Entering the members during the go-live phase of the imple- data was worth the mentation. The role effort because the for the informaticist information we re- Informaticists provide shoulder-to-shoulder is expanding even ceived helped keeping support for clinical staff members during the further as organiza- up with patients’ often go-live phase of tions recognize the rapid physical changes. implementation. value a nurse infor- It was this realization maticist can bring. that first got me in- An example that volved in what is now called informatics. emphasizes the value of an EHR and role of the nurse informaticist was when both the Cleveland Implementing EHRs Clinic and a competitor were implementing the Carolyn Sipes: During the past 11 years, I have same EHR system. A patient had tests and radio- worked as a consultant with several health systems, graphs performed at one facility, and a physician both nationally and internationally. Even today, I see told me how he had cancelled tests and radiographs the same issues arise with EHR implementation he had ordered for the patient because the tests regardless of whether they are large or small im- had already been run at the competing hospital. plementations, or whether they are national or inter- Working with the nurse informaticist who facili- national implementations. The one consistent theme tated the communication between the two hospi- throughout all of these implementations is the lack of tals, he said he trusted their results and would use communication and understanding between what those instead. The philosophy of using a national information technology department personnel think EHR system and adding the skills of a nurse in- should be implemented for clinical staff members formaticist who understands the functions of both versus what the nurses and other clinical staff mem- has saved many health care dollars. bers really need to complete their day-to-day tasks. Health systems are becoming better at recognizing the Supporting Nurses’ Work need and value of the nurse informaticist who can Toni Hebda: Nurse informatics supports the work facilitate the process and communication between the that nurses do. It allows quick access to information two specialties. when and where it is needed by the people who In the past, and even today, one of the key risks need it to facilitate the delivery of safe, effective for project failure in an EHR implementation is patient care, support administrative decisions, and when it is the sole responsibility of the information enhance the education of nursing students, health technology department to design a system for care consumers, and the public through the use of clinical users without their input into what is well-designed and well-used technology. Nurse required for them to successfully complete their informaticsprovidesthetoolstomakenursing

326 j AORN Journal EVERYDAY INFORMATICS www.aornjournal.org contributions to health care delivery visible, Dee McGonigle, PhD, RN, CNE, FAAN, ANEF, support research, and allow virtual real-time is the chair of virtual learning environments and decision making through the use of analytics, professor of graduate programs at Chamberlain which is a method that allows the discovery and College of Nursing, Columbus, OH. communication of meaningful patterns in large Dr McGonigle has no declared affiliation that unorganized data sets. Nursing informatics is an could be perceived as posing a potential conflict exciting area of specialization that focuses on of interest in the publication of this article. working smarter, not harder. Kathy Hunter, PhD, RN-BC, CNE, is the dean, Editor’s note: The second edition of the Periop- MSN Indirect Care Tracks, Chamberlain erative Nursing Data Set (PNDS) was superseded College of Nursing, Columbus, OH. Dr Hunter by the third edition (PNDS 3) in 2011. The PNDS has no declared affiliation that could be perceived 3 terminology is only distributed through AORN as posing a potential conflict of interest in the and AORN SyntegrityÒ licensed vendors. For publication of this article. questions about PNDS 3 implementation into Carolyn Sipes, PhD, RN-BC, CNS, APN, PMP, the EHR and electronic perioperative record is an associate professor, MSN Program Online, solutions, please contact the AORN Syntegrity Chamberlain College of Nursing, Columbus, team via e-mail at [email protected] OH. Dr Sipes has no declared affiliation that Syntegrity is a registered trademark of AORN, Inc, could be perceived as posing a potential conflict Denver, CO. of interest in the publication of this article.

References Toni Hebda, PhD, RN-BC, MSIS, CNE, is a 1. McGonigle D, Mastrian K. Nursing Informatics and the professor, MSN Program Online, Chamberlain Foundation of Knowledge. 3rd ed. Burlington, MA: Jones College of Nursing, Columbus, OH. Dr Hebda & Bartlett; 2015. 2. Hebda TL, Czar P. Handbook of Informatics for Nurses & has no declared affiliation that could be Healthcare Professionals. 5th ed. Upper Saddle River, NJ: perceived as posing a potential conflict of Prentice Hall; 2013. 3. Petersen C, ed. Perioperative Nursing Data Set. 3rd ed. interest in the publication of this article. Denver, CO: AORN, Inc; 2011.

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