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International Journal of Medical Informatics (2005) 74, 857—860
EDITORIAL
Nursing informatics: Current issues around theworld
Since information technology was included as a toolin the hospitals and healthcare facilities, the pro-cess of decision making, control and evaluationof nursing care were significantly altered. Nursesalways have been in the business of processinginformation, even before computers were intro-
science, and nursing science designed to assist inthe management and processing of nursing data,information and knowledge to support the practiceof nursing and the delivery of nursing care [1]. Itis also identified as the integration of computerscience (hardware), information science (software)
duced into healthcare industry. Processing infor-mation became an integral part of the nursingprofession. Nurses depend on accurate and timelyaccess to appropriate information to perform thevariety of activities including patient care, admin-istration, consulting, education and training. Theinformation required is not only about technicalknowledge, scientific development, quality con-trol, clinical and administrative documentation butalso about human and material resources availableto deliver nursing care.
The decision for planning and delivering nursingcare is always based on the available information ofresources, science and technological development,patient needs and technical skills. The more spe-cific information one accesses to support clinicaldecisions, the better care can be delivered to thepatient.
and the nursing science (theory); computers ortechnology resources are used to process nursingdata into information and knowledge.
Since the early stage of nursing informatics,research, education and practices have developedconsiderably. Currently, it is virtually impossibleto practice or even to communicate without thesupport of any technology resource. Great achieve-ments have been reached by nurses across countriesto incorporate information technology in the dailypractice.
It is also recognized that sharing internationalexperience enhances future nursing informaticsspecialists. What value one can find in growingalone; having no one for sharing, no one to whomyou can sell your ideas, your products? Every devel-opment inside one country is a dead end if it cannotpass the frontiers of that country [2].
Furthermore, the quality of care is related to thesccitbno
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These considerations lead us to prepare this spe-cwmwc
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cope of knowledge and information that health-are providers can access to underpin the clini-al decision making process. Technology plays anmportant role to facilitate access to the informa-ion. Gradually professionals around the world areecoming more aware of possibilities to apply tech-ology resources to perform activities in taking caref clients/patients.
Nursing informatics (NI), as originally defined iscombination of computer science, information
386-5056/$ — see front matter © 2005 Published by Elsevier Ireoi:10.1016/j.ijmedinf.2005.09.003
ial issue in nursing informatics. The main goalas to provide a means for sharing the ulti-ate experiences among professionals around theorld that are building higher quality of nursingare.
This special issue congregates seventeen articlesrom United States, Norway, Korea, Finland, Theetherlands, Ireland, Sweden, Australia and Bel-ium. They cover different aspects and differentoints of view related to the use to technology to
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858 Editorial
assure quality of nursing care, education, researchand management.
To guarantee that useful information is availableto perform and support continuity of care delivery,patient data must be documented in the patientrecord. Integration of patient data is essential toplan and deliver patient care. Consequently, infor-mation gathered at bedside has to be transferredfor use at home care or at any other facility toassure the continuity of care. Hellesø et al. [3]describe the management of information used byhospital and home care nurses for patients in needof continued patient care after an episode of hos-pitalization in Norway.
Considering nursing the art and science of car-ing for people, nursing interventions must be docu-mented to describe needs and status of patients.Florin et al. [4] from Sweden describe a multi-professional collaborative work on classificationdevelopment to provide suggestions for an organiz-ing structure that can capture interventions in thehealth care services incorporating different profes-sional perspectives.
Documentation is critical to promote continu-ity of patient care; it is also the instrument for
informatics is a common topic presented in theliterature. Although the importance of informaticscompetencies is worldwide recognized, these com-petencies have yet to be widely incorporated intonursing curricula at the undergraduate or graduatelevel in several countries.
Desjardins et al.[8] describe the effect of anevolving ‘‘Informatics for Evidence-Based Prac-tice’’ (IEBP) curriculum on nursing informatics com-petencies in three student cohorts in the combinedBS/MS program for non-nurses at the Columbia Uni-versity School of Nursing, New York, USA. Theirexample can be easily adopted by schools of nursinginternationally.
In the United States, McNeil et al. [9] alsoconducted a national online survey involvingdeans/directors of 266 baccalaureate and highernursing programs. The objectives were to identifynursing informatics competencies and knowledgeof undergraduate and/or graduate students in theirnursing programs; to determined faculty prepared-ness to teach NI and to use informatics tools; andto provide perceptions of NI requirements of localpracticing nurses.
Garde et al. from Australia [10] emphasize thataortetasc
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sharing information among providers. Collins andWagner [5] describes some of the ways their hos-pitals in United States monitor the quality of dataand adherence to documentation policies, as wellas how they use the data from the computerizedpatient records for healthcare quality initiatives,medical research and support of accurate charging.
In addition, documentation provides the meansfor analyses and evaluation of the quality of patientcare. Kim and Park [6] conducted a study to identifythe current status of nursing documentation with anemphasis on nursing outcomes through an analysisof the nursing record in clinical settings in Seoul,Korea.
According to Sermeus et al. [7], Belgium has a15-year tradition of collecting hospital data, devel-oping the Hospital Discharge Dataset (HDDS) that isfully implemented since 1990’s. Moreover, Belgiumis still one of the few countries that complementits HDDS with a nationwide uniform Nursing Mini-mum Dataset (B-NMDS). The article introduces usto the revision and implementation of the NursingMinimum Dataset. It emphasizes that the aim ofthis revision is to take into account the changes innursing practice, the international development ofnursing languages and classifications, the changesin healthcare management, and the need for inte-gration of the B-NMDS with the HDDS.
Education is and will always be an importantaspect in nursing informatics. Curriculum con-tent and definition of competencies in nursing
s nurses are using even more information technol-gy, they need to be adequately educated for theiroles in Health Informatics. They developed a ques-ionnaire to survey nurses on the preferred knowl-dge/skills set for Health Informatics Professionalso ascertain their individual perceptions of needsnd priorities. The results are also presented in thispecial issue so that professionals from differentountries can benefit from their achievements.
From Netherlands, van Beek et al. [11] shareheir experience on linking nursing care to medi-al diagnoses. The authors describe the use of theiagnose Behandeling Combinatie (DBC; Diagnosisreatment Combination) system which contains apecific care profile for each stated need for care.mong others, they conclude that the commonal-
ties and differences between medical diagnosesnd/or treatments are not easily described in termsf nursing diagnoses and nursing interventions. Inome cases, nursing care fits well to a medical diag-osis: in these instances nursing care is also homo-eneous.
In Ireland, the Health Service Reform Programs causing critical changes in the health service.ursing developments in the form of an automated
ntegrated nursing information system (INIS) andts integration within the electronic patient recordEPR) in one large acute university general teach-ng hospital is considered as an important event inhe context of the health service reforms. Murnane12] outlines some of the reforms taking place in
Editorial 859
Ireland, and demonstrate how integration is crucialto the success of these reforms.
Around the world we observe that developmentsin healthcare systems caused by the adoption ofhealth informatics are changing the delivery pro-cess and stimulating greater advances. Patel andCurrie [13] bring us the discussion about how cog-nitive science provides a framework for the analysisand modeling of complex human performance. Thearticle mention how studies of clinical cognitioncan meaningfully inform and shape design, develop-ment, and assessment of information systems, hav-ing impact on whether information technology hasa positive influence on human performance. Suchstudies are especially important in understandingand promoting safe practices. The authors arguefor a place of prominence for cognitive sciencein understanding nursing factors associated withpatient safety.
It is necessary to point out that research findingsmust be translated into daily practice. Weaver et al.[14] emphasize that there is extensive literature onthe barriers and difficulties of translating researchfindings into practical application. Their articlepresents three interesting collaborative strategiestp
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particular, within the United States, by the year2000, 30 states were already defined as experi-encing a nursing shortage by the Health Resourcesand Services Administration (HRSA). The ShortageDesignation Branch in the HRSA Bureau of HealthProfessions National Center for Health WorkforceAnalysis develops shortage designation criteria anduses them to decide whether or not a geographicarea or population group is a Health ProfessionalShortage Area or a Medically Underserved Area ofPopulation. Courtney [17] conducted a local studyin Missouri, United States to identify how HealthProfessional Shortage Area (HSPA) can adequatelyreflect areas of nursing need. In addition, theauthor also investigated if there were significantgroup differences or trends in the number of regis-tered nurses adjusted for population between 1991and 2001 between HSPA and non Areas-HPSA coun-ties. The results can be used by other countries thatare facing the same challenge in healthcare area.
Hovenga et al. [18] emphasize that much workhas been undertaken internationally in the areaof nursing terminologies and evidence based prac-tice. Their article argues that to make the mostof these emerging technologies and EHRs it is nec-eiecn
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hat aim to minimize this gap between research andractice.
On the other hand, management plays an impor-ant role to the success of health organizations.urrently, management of health care organiza-ions is becoming a more and more demanding andomplicated task. Increased networking betweenealth care service providers and various workforceevelopments have created a greater need for coor-ination and integration across organizational unitsn order to improve health care and the efficientelivery of services. Furthermore, the developmentf information and communication technology sys-ems demands the involvement of skilled healthare professionals. These professionals need toave comprehensive knowledge of patients/clientso make useful contributions to the project. Care-ul evaluation is needed to assess the effectivenessf project management as well as to analyze theommitment of the personnel to goal attainment.o better illustrate this assumption, Kouri et al. [15]onducted a research project to evaluate what fac-ors enhanced or impaired their commitment to theroject work.
Another important aspect to be considered ishe worldwide concern about nursing shortage.he International Council of Nurses has recog-ized a growing world-wide professional nursinghortage in the following areas: Australia, Canada,ew Zealand, the United States, the Philippines,estern Europe, Africa and South America [16]. In
ssary to concentrate on developing a process todentify, document, implement, manage and gov-rn our nursing domain knowledge as well as toontribute to the development of relevant inter-ational standards.
Currie [19] pointed out how important is to per-orm rigorous evaluation of informatics applicationsn healthcare. Traditionally, several quantitativeethods have been employed to evaluate informat-
cs systems. A trend to utilize qualitative and quan-itative evaluation methods in the development andost-implementation phases of informatics systemsevelopment has been observed. Recommendationsegarding the timing, type and use of qualitativeethods differ for available frameworks. Thisaper examines the strengths and weaknesses ofhe published evaluation frameworks and enumer-tes the qualitative research methods in use in eachf these frameworks.This special issue would note complete without an article about open source.yri and Murray [20] prepared a paper to introduceome of the many free/libre/open source (FLOSS)pplications that are now available to developnteractive websites and dynamic online communi-ies as part of the structure of health informaticsrganizations, and to show how the Open Sourceursing Informatics Working Group (OSNI) of thepecial Interest Group in Nursing Informatics ofhe International Medical Informatics AssociationIMIA-NI) is using some of these tools to developn online community of nurse informaticians
860 Editorial
through their website (www.osni.info).In general,we observed that nurses in the past have facedmany challenges and most of them have helped toenhance practice and activities. Caring for the illor injured will still be an essential part of nursing,but helping people stay healthy and functional willbe always the primary goal. The most importantskill of nursing will still be care. Personal humaninteraction is vital to recovery. Consequently, goodtechnology can not interfere in the way humansrelate to each other. Technology adoption is aprocess not a product that demands integrationamong systems. In fact, integration depends onthe integration among heath care professionals,and between providers and patients.
The articles presented in this special issuehighlight different aspects of nursing informatics’development around the world. Several high qualitypapers were received for publishing and selectingthese articles was a real difficult task. We hope thatthe information presented here can be used in yourprofessional life. We wish you a good reading!
References
[8] K.S. Desjardins, S.S. Cook, M. Jenkins, S. Bakken. Effectof an informatics for evidence-based practice curriculumon nursing informatics competencies. Int. J. Med. Inform.,this issue.
[9] B.J. McNeil, V.L. Elfrink, S.T. Pierce, S.C. Beyea, C. J. Bick-ford, C. Averill. Nursing informatics knowledge and compe-tencies: a National Survey of Nursing Education Programs inthe United States. Int. J. Med. Inform., this issue.
[10] S. Garde, D. Harrison, E. Hovenga. Skill needs for nurses intheir role as health informatics professionals: A survey inthe context of Global Health Informatics Education. Int. J.Med. Inform., this issue.
[11] L. van Beek, W.T.F. Goossen, W.A. van der Kloot. Linkingnursing care to medical diagnoses: heterogeneity of patientgroups. Int. J. Med. Inform., this issue.
[12] R. Murnane. Empowering nurses—–improving care. Nurses’response to the New Health Services Reform Programme inIreland. Int. J. Med. Inform., this issue.
[13] V.L. Patel, L.M. Currie. Clinical cognition and biomedicalinformatics: issues of patient safety. Int. J. Med. Inform.,this issue.
[14] C.A. Weaver, J. Warren, C. Delaney. Bedside, classroom andbench: collaborative strategies to generate evidence-basedknowledge for nursing practice. Int. J. Med. Inform., thisissue.
[15] P. Kouri, R. Karjalainen-Jurvelin, J. Kinnunen. Commitmentof project participants to developing health care servicesbased on the Internet technology. Int. J. Med. Inform., thisissue.
[16] International Council of Nurses. ICN Credentialing Forum
[1] J.R. Graves, S. Corcoran, The study of nursing informatics,Image. J. Nurs. Scholarsh. 21 (1989) 227—231.
[2] H.F. Marin, The frontiers for nursing and health care infor-matics, Int. J. Med. Inform. 74 (2005) 695—704.
[3] R. Hellesø, L. Sorensen, M. Lorensen. Nurses’ informationmanagement across complex health care organizations. Int.J. Med. Inform., this issue.
[4] J. Florin, M. Ehnfors. Developing a national integrated clas-sification of health care interventions in Sweden. Int. J.Med. Inform., this issue.
[5] B. Collins, M. Wagner. Early experiences in using comput-erized patient record data for monitoring charting compli-ance, supporting quality initiatives and assisting with accu-rate charging at allina hospitals and clinics. Int. J. Med.Inform., this issue.
[6] Y.J. Kim, H. Park. Analysis of nursing records of cardiac-surgery patients based on the nursing process and focusingon nursing outcomes. Int. J. Med. Inform., this issue.
[7] W. Sermeus, K. van der Heede, D. Michiels, L. Delesie, O.Thonon, C. van Boven, J. Codognotto, P. Gillet. Revising thebelgian nursing minimum dataset: from concept to imple-mentation. Int. J. Med. Inform., this issue.
Overview. 2000. Available at the URL: http://www.icn.ch/forumoverview.pdf. Accessed December 16, 2004.
[17] K. L. Courtney. Visualizing nursing workforce distribution:policy evaluation using geographic information systems.Int. J. Med. Inform., this issue.
[18] E. Hovenga, S. Garde, S. Heard. Nursing constraint modelsfor electronic health records: a vision for domain knowledgegovernance. Int. J. Med. Inform., this issue.
[19] L.M. Currie. Evaluation frameworks for nursing informatics.Int. J. Med. Inform., this issue.
[20] K. Øyri, P. J Murray. osni.info—–using free/libre/open sourcesoftware to build a virtual international community for opensource nursing informatics. Int. J. Med. Inform., this issue.
Heimar F. Marin a,b,c,∗a Federal University of Sao Paulo, Sao Paulo, Brazil
b IMIA NI SIG, USAc Brazilian Health Informatics Society, Brazil
∗ Tel.: +55 11 50821036/99146300.E-mail addresses: [email protected],
