Nursing Informatics and
Evidence-based Practice
Chapter 13
Strategic HIT Planning for the
Decade 2004-2014

The Decade of Information Technology
(Thompson, & DHHS, 2004)

Information Technology (IT)

Critical needs of the health care system
– Avoid medical errors
– Improve use of resources
– Accelerate diffusion of knowledge
Strategic HIT Planning for the
Decade 2004-2014 (cont'd)

Reduce variability in access to care

Advance consumer role

Strengthen privacy and data
protection

Promote public health and
preparedness
Strategic HIT Planning for the
Decade 2004-2014 (cont'd)
 Established
four goals
– 1) Inform clinical practice
– 2) Interconnect clinicians
– 3) Personalize care for
clients
– 4) Enhance public health
Nursing Informatics
 Emerging
field
 Informatics refers to:
– Broader field of understanding the
information needs
– How information can or should be stored
and retrieved
– How to use information technology
Nursing Informatics (cont'd)

Part of the larger field of health care
and medical informatics

Mechanism to collect and analyze
data from nursing care

Establish and maintain
computerized documentation
systems
Strategic Directions for Nursing
Informatics

Include informatics in nursing education

Prepare nurses with specialized informatics
skills

Enhance nursing practice and education
through informatics projects

Increase nursing faculty preparation in
informatics

Encourage collaboration
Question
 Is
the following statement true or false?
The specialist in nursing informatics
helps to build a systematic nursing
language, making data more secure
from hackers and enhancing the ability
to use the data to build aggregated
information upon which insurance
decisions can be based.
Answer
False.
Rationale: with an interdisciplinary focus, the
specialist in nursing informatics helps to
systematize the nursing language, making
data more retrievable and enhancing the
ability to use the data to build aggregated
information upon which practice decisions can
be based.
One aspect of this work is to make electronic
health care information safe, but has nothing
to do with insurance decision making.
Using Information Technology
Within the Care Setting

Employers expectations

Understanding IT
systems
– Security systems
– Billing systems
– Patient information
retrieval
Using Information Technology
Within the Care Setting (cont'd)

Order entry

Nursing data entry

Computerized medication
administration systems

Other computer resources
Accessing Information Resources

Texts and reference
books

Libraries

Policies and
standards
Accessing Information Resources
(cont'd)
 The
Internet
– E-mail
– Online group discussions
– World Wide Web
– Search engines
– Health-related Web sites
– Blogs
 Bookmarking
Web sites
Healthcare Indexes for Finding
Information Resources

Indexes available
– MEDLINE, produced by the National Library of
Medicine (NLM)
– CINAHL (Cumulative Index for Nursing and
Allied Health Literature), produced by the
CINAHL corporation
– International Nursing Index
– RNdex
– Hospital Literature Index
Healthcare Indexes for Finding
Information Resources (cont'd)

Psych Index

Social Sciences Index

Many journals publish their own
annual index
Healthcare Indexes for Finding
Information Resources (cont'd)
 Techniques
for effective searching
– Subject
– Author
– Thesaurus for the index
– Understanding the ways in which publications
are indexed
– Key words
Question

Jeff Scott, RN, is a graduate nurse just starting
his practice in a transplant step-down unit that
deals mostly with heart and lung transplants.
He finds that there are many ethical issues in
his practice that he was not expecting.
Jeff chooses to deal with these issues by
starting a blog on the Internet. What is a blog?
A. Online group discussion
B. Online journal
C. E-mail server site
D. Ethical discussion board
Answer
B. Online journal
Rationale: a blog (short for web-log)
is a web site on which an individual
(the blogger) publishes a journal
providing information and opinion
usually in relationship to a particular
area of subject matter.
Evidenced-based Practice
 Development
 Types
of evidence used
– Research studies
– Patient care data
– International, national, and local
standards
Evidenced-based Practice (cont'd)

Infection control data

Pathophysiology

Cost-effectiveness
analysis

Patient preferences
The Research Process

Statement of
problem/question

Review of literature

Theoretical framework

Refining the plan

Implementing the study
The Research Process (cont'd)

Analyzing the data

Presenting and interpreting
findings

Limitations

Disseminating research
results
Question

In some nursing studies it falls to the staff nurses
to collect the data for the study. When this
happens, it is important that:
A. Everyone learns the collection process from
each other.
B. The researcher picks out only the data that
interests them.
C. The researcher teaches everyone to collect
the data in a specific way.
D. Everyone learns the collection process from
the charge nurse on their shift.
Answer
C. The researcher teaches everyone to collect
the data in a specific way.
Rationale: if multiple people are collecting
data, it will be important to ensure that all are
carrying out the study tasks in the same way.
If different data collectors function differently,
the results of the study may not be accurate.
Reading Research
 Types
of
research
–
–
–
–
Quantitative
Qualitative
Combined
Metaanalysis
Reading Research (cont'd)
 Understanding
research
terminology
–
–
–
–
–
Abstract
Research question and purpose
Hypothesis
Population vs. sample
Groups
Reading Research (cont'd)

Variable

Validity and reliability

Probability and statistical
tests

Clinical significance
Legal and Ethical Considerations in
Research

Institutional approval
– Institutional review board
– Educational institution review
board
– Funding agencies
Legal and Ethical Considerations in
Research (cont'd)
 Consent
for research
– Informed consent
– Formal consent form
o Describes the researcher’s credentials
o How the participant was chosen
o Purposes of the research
o Procedures that will be followed
Legal and Ethical Considerations in
Research (cont'd)
• Risks
• Discomforts
• Benefits expected
• Guaranteed anonymity or at least confidentiality
• If alternative treatments are available, they must also
be described
• Participation is voluntary and can be terminated at any
time
Question

Is the following statement true or false?
The beginning of a code of conduct
pertaining to research was the
Nuremberg Code. This document has
been updated and modified several
times, the last time being in 1983.
Throughout these revisions a single
theme has been: first, do no harm.
Answer
True.
Rationale: the most recent revision of this code
was in 1983 (Code for Federal Regulations,
1983). Three principles guide these
regulations. First, the research should do no
harm. Second, the participants should be free
from exploitation. Third, there should be careful
attention to the risk:benefit ratio of the
research.
Personal Involvement in Research
 Identifying
problems
– Excellent observers
– Responsible for putting the whole complex of
patient care together
 Assisting
with ongoing research
– Your patients
– Follow procedures and protocols exactly
– Frontline safeguards
Systematic Analysis of Information
and Evidence
Reliability of the source
 Bias of the source
 Timeliness
 Purpose
 Comparing settings or
situations

Implementing New Practices
Based on Evidence

Institutional development of EBP
– Iowa Model of Evidence-based Practice
– ACE Star Model of EBP for Knowledge
Transformation
– Focus on continuous improvement
– Barriers to utilizing research in practice
Implementing New Practices
Based on Evidence (cont'd)
 Staff
nurse role in EBP
– Identify sources of evidence that can be helpful in
an individual nursing environment
– Evaluate that evidence in relationship to your
setting
– Work collaboratively to introduce changes based
on the evidence
– Evaluate the effectiveness of the changes