Population: Nurses who serve as the care providers who design, manage, and coordinate care, and are also are members of a profession in health care discipline
Intervention: Nursing informatics in nurses gets developed from a combination of computer science, information science, cognitive science and nursing science in which they use to undertake their roles
Comparison: Clinical judgment in nurses develops a deeper knowledge and clinical experience and is applied by nurse in taking their roles
Outcome: Effective decision-making support in nursing practice that is core to providing the best healthcare
PICOT Question: Are nurses more accurate and efficient in undertaking their functions and settings through integrating nursing informatics compared with using nursing judgment in their decision-making in nursing practice?
Nursing informatics gets defined as the product of the scientific synthesis of information in nursing since it makes use of concepts from computer science, information science, cognitive science and nursing science. Nursing informatics has continued to evolve as many professionals access, use and then develop the information, computer and cognitive sciences required to advance nursing science for the dual betterment of our patients and our profession. The American Nurses Association (ANA) describes nursing informatics as the specialty in which nurses utilize data, information, knowledge and wisdom to support nurses, patients and other medical staff in making a decision concerning their duties and settings (American Nurses Association (ANA) (2015)). A significant aspect of nursing informatics is communication and transmitting information. The use of nursing informatics as a guide, nurses has become increasingly more involved in management, use, design and assessment of information systems in the healthcare facilities and institutions. Nursing informatics has enabled nurses to identify and develop new ways of using computers and information science as tools to support their practice in undertaking their responsibilities.
Nursing informatics implementation requires healthcare professionals to view nursing informatics from the perspective of our current healthcare delivery system and specific, individual, organizational needs. Competence in nursing informatics gets possessed mostly by people with the ability to acquire, store, retrieve and communicate data, information, knowledge, and wisdom that is essential to nursing practice.
Nursing professionals get regarded as knowledge workers and handle information on a daily basis. They continually process data and information to give the best care possible for their patients. Nursing informatics facilitates the use of data, information and knowledge to assist patients, nurses and other medical practitioners in decision-making in all roles and settings. The support given to the various providers gets attained through the use of information structures, information processes, and information technology. Nursing informatics specialists collaborate with informatics technician and others to offer clinical information and data analysis for providing quality healthcare. The specialists work with computers, data analysis systems and nursing knowledge and experience to ensure that effective care gets offered. The nursing informatics specialists use computer science, nursing science and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.
Megastructures: Data, Information, Knowledge and Wisdom
Data refers to raw facts while information refers to processed data that has a certain meaning. The raw facts are the basic elements (atomic structure) or uninterpreted building blocks for the composition to knowledge. Data are discrete entities set objectively without interpretation, while information is data that gets interpreted, organized or structured. Information is a central concept and healthcare’s most valuable resource. Information science and systems, as well as computers, are constantly changing the manner in which healthcare organizations conduct their business. Information is data that gets interpreted using knowledge. Information gets regarded as valuable when it is accessible, accurate, timely cost effective, complete, flexible, reliable, relevant, verifiable, simple, and secure (McGonigle & Mastrian, 2009). We acquire information through actively looking for it or having it conveyed to us by our environment. We employ all the five human senses that are; vision, smell, touch, hearing and taste to gather input from the world around us as well as technologies mature, we will have more and more input through more of our senses. Today, we obtain knowledge from our computers (output), through our vision, hearing, or touch (input), and we respond (output) to the computer (input), and this is how we interface with technology. Most individuals connect to the Internet on a daily basis seeking information or imparting information. We are continuously becoming informed, discovering or learning, getting reinforced, rediscovering or relearning, and purging what we have acquired. The information that we acquire gets added to our knowledge base. Knowledge is information that has got synthesized so that relationships get determined and formalized. Data that has got processed to create information and then knowledge may get acquired from individuals, families, societies and populations and the environment in which they exist. Knowledge describes the awareness and understanding of a set of information and approaches that information can get made meaningful to support a particular task or in decision-making (McGonigle & Mastrian, 2009). Knowledge building is a continuous process that we take part in while we are conscious and going about our normal daily activities.
Examples that outline nursing knowledge include modeling the expert nurse’s decision-making to give computerized decision support to improve clinical judgment or elaborating on the knowledge resources at play to construct standards, common guidelines, and procedures (Moen & Mæland Knudsen, 2013).
Wisdom in nursing practice refers to the appropriate use of knowledge in managing or finding solutions for various human needs (Treas & Wilkinson, 2013). Wisdom entails knowing when and how to apply knowledge to handle complex situations or specific human need. Knowledge emphasizes on what is known, while wisdom focuses on the suitable application of that knowledge. The appropriate application of knowledge entails the integration of empirical, ethical, personal and aesthetic knowledge in the process of implementing actions. The person must employ a high level of empirical knowledge in understanding the current situation, apply professional value system in considering potential actions, make predictions of the potential outcome of decisions with a high level of accuracy and then undertake selected action in the current environment. An applied wisdom that demonstrates the integration in nursing informatics is the proper use of information management and technological tools to support the effective nursing practice. Data, information, knowledge, and wisdom, are of concern to nurses in all aspects of practice.
Advantages of nursing informatics
- Shared data, improved data integrity, improved data security and database systems and centralized control hence leading to effecting moral and well-informed decision making as well as information assurance.
- Improved methods of health care delivery and documentation of nursing informatics incorporate information technology.
- Increases productivity by avoiding bulk and unnecessary work and also streamlines accuracy and analysis of clinical data.
- Flexible conceptual design
- Disadvantages of redundancy control
- Improved documentation within medical facilities hence leading to reduced operating and patient care costs and also improved quality of care
Disadvantages of nursing informatics:
- It is a complex conceptual design process
- High database management acquisition costs as well as highly dependent database management operations.
- May lead to potentially catastrophic program failures
- Requires multiple external databases
Clinical judgment refers to the informed opinion that is using intuition, reflection, and critical thinking that relates observation and evaluation of patients to determining and assessing alternative nursing options (Standing, 2014). Clinical judgment entails reviewing the potential impacts (risks and benefits) of possible alternative actions before committing to a particular choice. Becoming an efficient and competent nurse entails more than critical thinking and the ability to use the nursing process. It relies majorly on developing excellent clinical judgment in nursing practice. Clinical judgment comprises of informed opinions and decisions based on empirical knowledge and experience. Clinical judgment gets developed gradually as nurses gain broader, deeper knowledge base and also clinical experience. The best means of developing clinical judgment is through extensive direct patient contact. Critical thinking, as well as clinical reasoning used in the nursing process, are both important aspects of the clinical judgment. A nurse who as developed sound clinical judgment understands what is required and what to look for, draws valid conclusions about possible alternative meanings of signs and symptoms and knows what to do about it. Developing sound clinical judgment entails recalling facts, recognizing and realizing patterns in patient behaviors, combining facts and observations to create a meaningful whole and acting on the resulting information in a suitable manner.
It is important for healthcare professionals to understand their limitations of their expertise as an important aspect of clinical judgment. Many nurses have developed instinctive awareness during the time they approach the limits of their expertise and usually seek consultation with other medical professionals as required. The development of excellent clinical judgment is a professional responsibility because all nurses have an obligation to provide the best care to patients based on research and clinical evidence. Nurses are also accountable for their decisions in their professional practice and nursing practice caused by those decisions.
Decision-making links judgment to practice by acting on it in selecting from the available options. In nursing practice, nurses are accountable for the quality, safety, and effectiveness of their clinical decision-making. In nursing practice, the nurse is a safe, caring as well as competent decision maker willing to accept personal and professional accountability for their actions and continuous learning. The nurses’ practice within a defined statutory framework and code of ethics delivering nursing care that is suitably based on research evidence and critical thinking that effectively meets the individual needs.
American Nurses Association (ANA) (2015): Nursing Informatics: Scope & Standards of Practice: Silver Springs
McGonigle, D., & Mastrian, K. (2009): Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
McGonigle, D., & Mastrian, K. (2014): Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
Moen, A., & Mæland Knudsen, L. M. (2013): Nursing informatics: decades of contribution to health informatics. Healthcare informatics research, 19(2), 86-92.
Standing, M. (2014): Clinical Judgement and Decision Making for Nursing Students. Learning Matters.
Treas, L. S., & Wilkinson, J. M. (2013): Basic Nursing: Concepts, Skills, & Reasoning. FA Davis.