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PubMed1996

Computers conquer hospital wards in Germany.

As a result of the Health Reform Act (1993) German hospitals have to prepare for fundamental changes in their accountability to the health insurance companies. For example, the introduction of diagnosis-related groups and competitive elements into the health care sector necessitate thorough recording of patient-related costs by each individual hospital. Consequently, the work done by nurses is to be measured in a more refined manner in order to obtain a correct picture of the overall costs for a particular treatment. Computer technology is seen as a suitable tool to meet the challenges of this new development. The Agnes Karll Institute of Nursing Research (German Nurses' Association) conducted a study in the hospitals of Hesse, Germany, in order to investigate the present state of nursing informatics and related questions. Some results will be outlined in this paper.

Germany↗
PubMed2000

Describing patient problems & nursing treatment patterns using nursing minimum data sets (NMDS & NMMDS) & UHDDS repositories.

Dramatic changes in health care have intensified practitioners' efforts to access and use information to determine more efficacious approaches to patient outcomes. The overall goal of the study is to measure the influence of nursing informatics clinical reasoning decision support interventions on patient outcomes. This paper describes Phases I of the study: the methodology for establishing and testing the usefulness of large data repositories comprised of three minimum data sets, including the Nursing Minimum Data Set (NMDS), the Nursing Management Minimum Data Set (NMMDS), and the Uniform Hospital Discharge Data Set (UHDDS), and the American Nurses Association Quality Indicators to support effectiveness research. The use of generic data modeling to construct a clinical nursing repository of more than 477,000 electronic records is discussed. Patient problem and treatment profiles, patterns, and variations based on standardized analyzing classifications are described for inpatient adult samples, and nursing and medical diagnosis groups.

Databases, Factual↗
PubMedDate not supplied

[Nursing on the Web: the creation and validation process of a web site on coronary artery disease].

The World Wide Web is an important health information research source. A challenge for the Brazilian Nursing Informatics area is to use its potential to promote health education. This paper aims to present a developing and validating model used in an educational Web site, named CardioSite, which subject is Coronary Heart Disease. In its creation it was adopted a method with phases of conceptual modeling, development, implementation, and evaluation. In the evaluation phase, the validation was performed through an online informatics and health experts panel. The results demonstrated that information was reliable and valid. Considering that national official systems are not available to that approach, this model demonstrated effectiveness in assessing the quality of the Web site content.

Coronary Disease↗
PubMed2005

New frontiers for nursing and health care informatics.

Health care and health information have been around since the time of Hippocrates or even before. Through the historical evolution, it is observed that the knowledge and information that were simple and easy to learn and retain by that time, became much more complex. This paper presents a brief reviewing on the evolution of MEDINFO conferences, and how nursing informatics grew up and made itself visible during all these years of IMIA conferences.

Brazil↗
PubMed1995

Informatics management: process model application.

The purpose of this paper is to share the results of a conceptual model application in informatics management and re-engineering. This theoretical construct is a four phase problem solving process shell which has distinct actions, descriptions, and deliverables with evaluation as an ongoing bridge. The process shell was used as a tool for a retrospective assessment of Nursing Informatics developmental waves and for prospective planning of the re-engineering wave. The authors feel this tool can be an invaluable guide for development, an instrument for planned change, and a paradigm for strategic planning.

Medical Informatics↗
PubMedDate not supplied

Patient satisfaction and normative decision theory.

This article explores the application of normative decision theory (NDT) to the challenge of facilitating and measuring patient satisfaction. Patient satisfaction is the appraisal, by an individual, of the extent to which the care provided has met that individual's expectations and preferences. Classic decision analysis provides a graphic and computational strategy to link patient preferences for outcomes to the treatment choices likely to produce the outcomes. Multiple criteria models enable the complex judgment task of measuring patient satisfaction to be decomposed into elemental factors that reflect patient preferences, thus facilitating evaluation of care in terms of factors relevant to the individual patient. Through the application of NDT models, it is possible to use patient preferences as a guide to the treatment planning and care monitoring process and to construct measures of patient satisfaction that are meaningful to the individual. Nursing informatics, with its foundations in both information management and decision sciences, provides the tools and data necessary to promote care provided in accord with patient preferences and to ensure appraisal of satisfaction that aptly captures the complex, multidimensional nature of patient preferences.

Decision Theory↗
PubMedDate not supplied

Redesigning a risk-management process for tracking injuries.

The changing responsibilities of registered nurses are challenging even the most dedicated professionals. To survive within her newly-defined roles, one nurse used a total quality improvement model to understand, analyze, and improve a medical center's system for tracking inpatient injuries. This process led to the drafting of an original software design that implemented a nursing informatics tracking system. It has resulted in significant savings of time and money and has far surpassed the accuracy, efficiency, and scope of the previous method. This article presents an overview of the design process.

Accidental Falls↗
PubMed2006

Linkage of patient records to support continuity of care: Issues and future directions.

Continuity of care depends on the availability of complete health care information on which current and future care can be planned and implemented. Consumers however, may have multiple records--even within single institutions--often unknown by the institution or the individual care provider. One of the first challenges to health care informatics professionals is to establish a means of identifying individual patients across care delivery systems. The ability to create an integrated record system depends on the development of a "universal person index" as well as considerations for standardizing and integrating other aspects of the electronic record. Many individual health facilities are working to create a "master person index" (MPI) and some integrated delivery systems are attempting to combine these MPIs into a single "enterprise person index" (EPI). Even more difficult is the task of establishing a means of identifying and linking patient records across all health care settings. Primary efforts to establish these linkages will depend on standardization across multiple MPI files, linkage protocols, data protection and patient consent. The nurse informatics specialist will be important to the planning, implementation, application and evaluation process necessary to the integration of health information records to support patient care.

Continuity of Patient Care↗
PubMed2006

Factors affecting the implementation of telenursing in Korea.

The purpose of this study is to deduce and prioritize the factors affecting the implementation of telenursing in Korea. For this study, Delphi methods were used. Thirty professors and specialists in the field of nursing informatics and telemedicine contributed to two rounds of Delphi survey. The factors necessary for the introduction of telenursing were divided into systematic, economical, societal and technical aspects. The critical factors of each aspect were prioritized to produce a guide to support the feasible implementation plan for telenursing. They are: Governmental support to control the regulatory issues, verification of telenursing as a cost-effective health care delivery system, value verification of telenursing versus on-site consultation, social trust building, and development of characteristic telenursing content which consumers willingly pay for. The results of this study will enable health professionals to understand the prospect and necessity of telenursing implementation. In addition, they will be used efficiently in a variety of e-health milieus as a practical strategy for the improvement of health care in Korea.

Diffusion of Innovation↗
PubMed2001

History and trends in clinical information systems in the United States.

PURPOSE: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics. ORGANIZING CONSTRUCT: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues. METHODS: Literature review and analysis. FINDINGS AND CONCLUSIONS: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.

Decision Making, Computer-Assisted↗
PubMed2004

Assessing informatics in Canadian schools of nursing.

The provision of informatics content in the basic education programs for Canadian nurses has been limited to date. In previous years, efforts to engage nurse educators in discussions regarding the significance of informatics for tomorrow's nurses had been met with limited interest and understanding. There was an obvious need to heighten the awareness and active participation of nurse leaders in the development of strategies to attend to the informatics education needs of Canadian nurses. This paper describes the findings of a national study to understand the current state of informatics integration within basic nursing curricula

Canada↗
PubMed2005

Using OrgAhead, a computational modeling program, to improve patient care unit safety and quality outcomes.

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement.

Arizona↗
PubMed2005

Analysis of nursing records of cardiac-surgery patients based on the nursing process and focusing on nursing outcomes.

This study analyzed what nurses wrote in narrative nursing notes for cardiac-surgery patients. The nursing notes of 46 patients were analyzed based on the nursing process. Eight patterns were extracted according to different combinations of nursing process components, of which an assessment alone was the most frequent nursing phrase (45.8%), followed by assessment or diagnosis-intervention-outcome (25.9%). The content of the nursing notes was also classified into 15 categories, of which nursing outcomes were recorded more frequently in nursing care driven mainly by physician's order such as disease-related symptom management, insomnia care, respiratory care, and pain control, than in independent nursing care such as education and emotional care. A survey on the attitudes of nurses toward the nursing record revealed that they do not document nursing outcomes as much as they think they do. The main reasons for this discrepancy were insufficient time for recording and lack of knowledge about why, how, and what to evaluate. Even though there is room for improvement, nursing notes represent a useful resource for determining nursing contributions to patient outcomes.

Cardiac Surgical Procedures↗
PubMed2005

Nurses' information management across complex health care organizations.

UNLABELLED: The purpose of this study was to describe the information management used by hospital and home care nurses for patients in need of continuing care after an episode of hospitalization. METHOD: A prospective descriptive design was used. In total 287 hospital nurses and 220 home care nurses were asked to complete a questionnaire before and after the hospital implemented nursing documentation integrated in the electronic patient record (EPR). RESULTS: Discrepancies between the policies expressed by the health care organizations and the authorities in formal documents and the information management used by the nurses were identified. Differences were also found between nurses in hospital and home care with regard to how they assessed the information management during patient admission, throughout the patient's hospital stay and at the patient's discharge. The perceived differences decreased, however, after the hospital introduced electronic nursing documentation. The study shows a need to contextualize and customize the information that nurses exchange. In addition technological problems with the lack of integrated EPR systems between the hospital and the home health care as well as different practice models in the two organizations entail complex information handling during a patient's trajectory through the health system.

Attitude of Health Personnel↗
PubMed2005

Early experiences in using computerized patient record data for monitoring charting compliance, supporting quality initiatives and assisting with accurate charging at Allina Hospitals & Clinics.

Allina Hospitals & Clinics has been an early adopter of electronic medical records in both their hospitals and clinics. This article describes some of the ways their hospitals monitor the quality of the data and adherence to documentation policies, as well as how they use the data from the computerized patient records for healthcare quality initiatives, medical research and support of accurate charging. A key feature of their work is real-time, on-demand reporting from any workstation.

Decision Support Systems, Clinical↗
PubMed2006

Knowledge work in nursing and midwifery: an evaluation through computer-mediated communication.

Recent changes in policy and culture require health workers to incorporate "knowledge work" as a routine component of professional practice. Innovative computer-mediated communication technologies provide the opportunity to evaluate the nature of "knowledge work" within nursing and midwifery. This study embedded an online discussion system into an acute NHS Trust to support interaction within communities of practice. The complete record of online communications was analysed. Nurses were found to predominantly engage in information work with knowledge work restricted to senior-to-senior level exchanges. In contrast, midwives were observed to employ the technology to support knowledge work between all grades. The study indicates that technology can support knowledge work, including conveying tacit knowledge effectively.

Acute Disease↗