Nursing Health Care Informatics "…At the beginning of the 21st century, nursing informatics has become a part of our professional activities…[and has] advanced the field of nursing by bridging the gap from nursing as an art to nursing as a science…" (Saba, 2001, 177).

Nursing Health Care informatics relate to and address technology and other cutting edge issues of great interest in the healthcare field. According to the AMIA, Nursing Informatics is the "…science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide." New and relevant knowledge presented in the genre of informatics helps to empower nurses and other healthcare practitioners to deliver the most effective patient-center care possible. This paper presents several informatics in the belief that applying healthcare technologies and practices that are genuinely progressive and helpful to today's nurse is a way of assuring that the practice will continue to be upgraded, challenged, and will lead to better outcomes for patients and healthcare practitioners.

Relevant Background -- Institute of Medicine Report

The 2010 report by the Institute of Medicine (IOM) titled "The Future of Nursing, Leading Change, Advancing Health," has made an impact on the field of nursing by offering what amounts to a "prophecy fort nurses to lead the transformation of health care" (Cipriano, 2011). Cipriano asserts that in order to improve the "…safety, quality, and efficiency of care" in the entire healthcare system, information technology (IT) is an appropriate and necessary approach. In that sense, Cipriano (PhD, RN, NEA-BC, FAAN), who serves as a Research Associate Professor at the University of Virginia School of Nursing, views the implementation of appropriate information technology as having great potential.

Guidance Provided by the Literature

The IT potential can help to empower nurses with the tools they need, Cipriano reports; she sites eight recommendations -- informatics -- that were presented by the IOM report. One, by using electronic health records (HER) -- provided by the Health Information Technology for Economic and Clinical Health Act -- nurses can better "collect, synthesize, and analyze quality data" (Cipriano). Two, all nurses must "step up" to leadership roles by sharing and embracing best practices with technology. That is, all nurses (not just those designated as "leaders") should be "deploying new technology" in order to understand and implement IT devices and systems that "enable care" (Cipriano). Three, new levels of competence can be achieved when nurses make the transition into new roles -- aided by the available electronic tools that simulate "patient experiences." Those new electronic tools include demonstration EHRs, "psychomotor skill applications," and "knowledge assessment tools" (Cipriano).

Four, there is a need to greatly enhance the proportion of nurses that obtain BSN degrees; the IOM report recommends that by 2020, the proportion of nurses with BSN degrees should be pumped up by 80% because more education means a greater knowledge base (Cipriano). Five, the number of nurses with PhD degrees should be doubled by 2020, in order to "…fill a critical void" when it comes to faculty shortages, Cipriano reports, based on the IOM research. Six, nurses must be expected to engage in "lifelong learning," and the use of healthcare IT will assure that the ongoing learning process is relevant to best practices as technology evolves. Seven, it isn't enough for nurses to "delegate responsibility for implementation of health IT systems to technologically competent staff," Cipriano asserts. Leaders must lead, and that means becoming comfortable with leading edge healthcare technologies. And eight, technology is "the key" to collecting and analyzing data, which provides "information, knowledge," and of course wisdom.

Relevant Background -- Theoretical Considerations

The development of theory in nursing and healthcare informatics, presented in the journal Advances in Nursing Science, posits that because 110 million American adults search for health information and services on the Internet, theoretically there must be a "unified model" presented to the online users. To wit, notwithstanding the enormous number of Americans who access healthcare information online -- and keep in mind this article is seven years old, so the number of users is clearly far more than 110 million -- very few online users report "…impacts on measurable healthcare utilization" (An, 2007). Based on surveys conducted by the authors of this article, "…more than 90% reported that Internet use had no effect on the number of physician visits or telephone contacts" (An, E38).

Hence, the authors recommend in depth study vis-a-vis the use of a model called the "Technology Acceptance Model" (TAM);...

Boiling it down to a basic approach, what the authors are proposing is a better way to understand healthcare consumers' "technology acceptance"; e.g., if users of the Internet who seek healthcare information and solutions to health-related issues don't find what they are looking for, it portends wasted moments and even frustration. And moreover, the goal of nursing informatics through the use of technology -- interrelating data, information and knowledge -- is not going to be achieved (An, E39).
TAM considered the theoretical base of a person's "technology acceptance" because it helps to link a consumer's "…beliefs, attitudes, behavior intentions, and actual usage" as to how consumers actually learn to accept and use new technologies, An explains (E41). The theoretical constructs in the ICTAM model, An continues -- "compatibility, perceived playfulness, and Web site loyalty" -- are based on a literature review of online healthcare information seekers (An, E41). The "ultimate objective of ICTAM" - which makes this a key part of this paper's healthcare informatics -- is to be able to predict "Web site usage and Web site loyalty" as those objectives relate to providing meaningful, practical healthcare information online (An, E45).

Guidance Provided by the Literature -- Informatics Nurses in Demand

In the peer-reviewed journal Nursing Management the author understates when she says "informatics nurses and their clinical informatics partners are in high demand," and because this article was published four years ago, no doubt there is greater emphasis on training and recruiting informatics nurses (Sensmeier, 2010). Technology is indeed changing the way in which clinicians work, Sensmeier explains, and "Fortunately, nursing and clinical informaticists are at the frontline of this transformation," which portends much improved the outcomes and safety related to patients (Sensmeier, 52).

The top three occupational responsibilities for informatics nurses are: a) implementation of systems and training; b) the development and the design of new systems; c) "…working in a liaison role such as representing the information needs of nurses to other areas or departments" (Sensmeier, 52).

The author of this piece presents a fairly typical conundrum that can occur when paper-based flow sheets transition into automated flow sheets. This provides an opportunity to reveal the value of nurse informatics because training nurses -- especially those that have been in the field for many years and may be resistant to dramatic change, which some might consider an imposition -- can be problematic. The way in which data was to be kept in the new technologically advanced system at the Children's Hospital in Pittsburgh -- in critical care settings -- was shown to nurses by nursing informaticists. Those nurses with advanced knowledge of the IT related to flow sheets and patient information worked through the issues with the on-site nurses by analyzing and uncovering -- step-by-step -- how the upgraded system works. The insights that the nursing informaticists provided was not without some resistance, and albeit "certain compromises had to be made," those clinicians are "now satisfied that the new tool has improved their effectiveness" (Sensmeier, 52).

In order to more seamlessly train nurses in the new technologies Dr. Pamela Cipriano (whose article was referenced earlier in this paper) makes four suggestions as to best practices in leveraging the technology. She asserts that the following will work if applied with clarity: a) ensure that nursing workflow -- as a "focus of healthcare IT funding" -- actually allows nurses to be more "efficient" in the process of delivering "safer care"; b) "advocate for nurses to be included in technology design and evaluation" and that will help nurses adopt quickly; c) show nurses how they can become "meaningful users of technology"; and d) support nurses in bringing "high-technology care into the hospital setting of the future -- the home and community" (Sensmeier, 53).

Guidance Provided by the Literature -- Resistance to Healthcare Informatics

Technology now makes it possible for doctors and nurses to monitor -- through advanced technologies involving telephones and computers -- and "directly measure and transmit assessments of vital signs, chest sounds, or images of wounds" from distant locations (Dienemann, et al., 2003). This is not to say that hands-on medical care is being discarded because new technologies are available; not at all. It simply means that it is now possible for a nurse or physician to monitor "…disease or wound management," or even assess a situation that is a healthcare emergency, from a distance (Dienemann, 557).

Moreover, because of the advancement…