Introduction to Nursing Informatics (Health Informatics)

“This book focuses on nursing informatics in the 21st century . The intended audience is practicing nurses and undergraduate student nurses. This would.
Table of contents

Nursing Informatics: Decades of Contribution to Health Informatics

This is of great significance, important in understanding the variations in clinical processes in sufficient detail and in acknowledging previous experiences. In reality, Matney et al. These are resources for skillful, competent clinical judgment, and they involve the contextual and intertwined nature of data, information, and knowledge.

Achievements in nursing informatics have inspired the systematization and formalization of information where data, structured information, and articulated knowledge are important building blocks for the development of IT-based applications. Most attention and in-depth study has been directed to describing information used in clinicians' judgments and modeling prototype applications for management that are decision-supportive. The studies also strive to provide the best evidence at the point of care to improve decision-making.

So far, feasible practice models giving new tools for information handling have received little attention, and reported studies are often examples of workflow failure [ 18 ] or unintended consequences [ 19 ]. When we zoom in on applications using achievements in health informatics, there is also a plethora of tools, devices, and applications aiming to support the management of data, information, and knowledge related to health and wellbeing.

The following types of applications add new opportunities and challenges to the field:.

Nursing Informatics: Decades of Contribution to Health Informatics

These types of applications present novel opportunities and important challenges to our field, but their interrelationships and how together they may contribute to efficient information are not fully understood [ 20 - 22 ]. The Problem-Oriented Medical Record [ 23 , 24 ] was among the first influential published implementation experiences where informatics supported health information management and health care processes. The core idea was to embed an information model that de facto restructured clinical documentation in the EHR, using a problem-oriented approach in an attempt to reengineer documentation processes.

The systematization of information elements, charted according to predefined templates or as narrative texts, most often follows the problem-oriented information model rather than models that deal with body systems, basic needs, or functional status, to represent nursing practice in an EHR. The "stickiness" of the problem-oriented structure for information models is seen globally, reflected as the information model in the globally diffused nursing process, suggesting structures for clinical documentation of nursing care [ 13 ].

The same information model is seen as a dimension of nurses' work currently supported by emerging nursing vocabularies [ 11 ] and as the commonly used structure for health care knowledge representations, as a resource for the design, implementation, and evaluation of health information systems, and as an inspiration for practice changes following the deployment of health information systems [ 25 ].


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Core features of nurses' work are teamwork, collaboration, and mobility. Nurses meet and interact with patients and their families in a variety of settings to contribute to prevention, early intervention, maintenance, or problem solving. Nurses typically care for many patients, and in a team, they assume key roles in coordinating patient care and treatment in collaboration with other providers [ 26 ].

Nurses collect a lot of data, and they access evidence at the nurses' station, at the bedside, in a person's home, or in an office. Incorporating contextual and environmental cues is crucial. These elements exemplify specific features of nurses' work and of their workflow. Lack of appropriate access to evidence at the point of need is a challenge for continuity of care and patient safety.

Lack of aggregate information for reporting and benchmarking has so far been detrimental to nurses' adoption of new technological tools. The EHR offers an interesting collection of quantitative data e.

Introduction to Nursing Informatics (Health Informatics)

More recent analytic techniques and approaches to the analysis of large amounts of data, or "Big Data," open up new ways of providing evidence to support knowledge development, decision-making, and interdisciplinary collaboration. Using information in the EHR means that the aggregation of authentic, real-time patient data offers opportunities for early intervention to prevent health problems or to manage existing conditions [ 28 ].

There are still unresolved issues of a professional, legal, and ethical nature with the new approaches to knowledge generation and to more information sharing within and across settings and levels of care [ 29 ]. As more health care activities migrate from hospitals to community care, the plethora of tools and functionalities follows. More work is needed to understand how better to integrate this information into the existing informatics infrastructure and into clinicians' suit of tools. Exciting opportunities for active collaboration with the patient and his or her family can be further developed through skillful use of EHRs in combination with the PHR.

A PHR contains information chosen, collected, and maintained primarily by the patient or a trusted family member. We know that people make tradeoffs between types of health information and health concerns as they use sophisticated and robust health information management strategies [ 30 ].

Therefore, information kept in the PHR will vary with the health concern and interest of the person keeping it. A PHR can be a stand-alone application set up and maintained at the discretion of the person keeping it. More common is some connection to organized health care services. Depending on institutional and organizational arrangements and provision of services, persons using such a PHR can access parts of their EHR securely and remotely, some can take advantage of secure mail for online interactions with the health providers as well for accessing relevant health information [ 20 , 31 ].

In addition, the PHR carries the potential to be an even more used and valued resource for accumulating health information and supporting health information management as care activities increasingly shift to focus on prevention and early intervention and actively include the extensive self-care efforts of the citizens themselves. As such, a PHR can be an important resource for nurses if the recipients of nursing care choose to grant access to their caregivers. To be even more valuable for multiple users and uses, practical ways of capitalizing on benefits from the explication, systematization, and formalization of data, information, and knowledge can help us move forward.

We believe that attention to wisdom and acknowledgment of the situational dimensions and specifics in nurses' interactions with their patients will open up new beneficial, collaborative relationships and further achievements. New areas of application of health informatics can be found in the use of the growing suite of tools for ambient assisted living and smart houses and in the new potentialities for generating practice-based evidence using "Big Data" analytic techniques.

New tools are increasingly used for personal monitoring and self-care activities, and we see expanding opportunities in applications labeled under the umbrella of mHealth or uHealth. These applications range from support for collecting personal observations, e.

Nursing Informatics

These are novel opportunities to support the individual's personal health information management and safety requirements to allow him or her to remain at the preferred home dwelling as long as possible. Unfortunately, many of these tools "live a life of their own," that is, they are not well integrated to existing health informatics suites of tools [ 36 ].

Applying techniques developed for "Big Data" to accumulate clinical information from different sources and in a variety of formats provides opportunities for the active use of authentic, real-time patient data in developing health care and practice changes that embrace new and novel opportunities for analysis of clinical information.

Among the future challenges are questions of how to incorporate these new opportunities to present sound, innovative care repertoires. It remains to be explored how such analytic techniques, applied to the plethora of available information, can add to knowledge and wisdom, and what future innovative practice models will be suggested. More research will also be appreciated to understand how to incorporate data from remote monitors in decision-making and clinical judgments without familiar, observational data to help in the interpretation of the discrete data.

Critical issues addressed by nursing informatics are data , information , and knowledge complemented by wisdom. These contribute to conceptual clarifications helping to depict clinical processes in sufficient detail to support clinical judgments and to streamline nursing representations. The design and deployment of IT applications in health care are examples of achievements where information handling and new modes of care delivery call for renewed attention to organizational issues to ensure feasible and innovative practice models.

As we move forward, nurses and other health providers will be challenged and invited to participate in processes to explore the use of clinical information systems in new ways and for new purposes. Mobility, new members of care teams, new analytic techniques, and more modalities are key issues. Keeping up a commitment to develop and implement tools that are supportive of nurses' and other health providers' work in collaboration with patients and their families calls for scrutiny and further elaborations of ease of use and digital literacy for all who are mindful of previous experience with the technology and with community uptake.

No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U. Journal List Healthc Inform Res v. Published online Jun Find articles by Anne Moen. Box , Blindern, N Oslo, Norway. Received May 29; Accepted Jun This article has been cited by other articles in PMC.

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Abstract Objectives In this paper we present a contemporary understanding of "nursing informatics" and relate it to applications in three specific contexts, hospitals, community health, and home dwelling, to illustrate achievements that contribute to the overall schema of health informatics. Results Conceptual clarification of nursing data, information and knowledge has been expanded to include wisdom.

Conclusions Exploring interplays of data, information, knowledge, and wisdom, nursing informatics takes a practice turn, accommodating to processes of application design and deployment for purposeful use by nurses in different settings. Introduction The introduction and use of new technology to support nurses in their care for patients always leads to change and the development of new service repertoires [ 1 ]. Methods To obtain an overview of more of the field, we searched different electronic databases, complemented by an author search and a hand search in especially relevant journals [ 4 ], in order to complement the practical examples.

Table 1 Search terms. Open in a separate window. Results The core issues in health informatics, where nursing informatics provides important contributions, are illustrated by the plethora of questions relating to automation. Conceptual Understanding of Nursing Informatics The seminal paper by Graves and Corcoran [ 10 ] in set the stage for conceptualizing the specialty of nursing informatics.

Application and Use of Informatics in Health Care Achievements in nursing informatics have inspired the systematization and formalization of information where data, structured information, and articulated knowledge are important building blocks for the development of IT-based applications. The following types of applications add new opportunities and challenges to the field: EHR is a repository maintained by health facilities, with a set of functionalities and services, that accumulates the health providers' assessments, actions, and evaluations of a person's clinical problems as separate episodes or over the life trajectory.

PHR is a repository maintained by the consumer, with a set of personal observations, information from health providers, and relevant information resources. The scope and comprehensiveness of the accumulating content in a PHR depends on the individual's effort. Smart assistive tools include stand-alone applications and tools for personal self-care activities for everyday, everywhere use.

Passive, environmental monitoring by sensors also supports the individual's personal health information management and safety.


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    • Conclusion Critical issues addressed by nursing informatics are data , information , and knowledge complemented by wisdom. Footnotes No potential conflict of interest relevant to this article was reported. Eur J Biomed Inform. What informatics is and isn't. J Am Med Inform Assoc. Conducting research literature reviews: Technical innovations in health care: American Nurses Association; Scholes M, Barber B. The role of computers in nursing. Nurs Mirror Midwives J. Staggers N, Thompson CB.

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